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Washington University Experience | VASCULAR | Infarct - Embolic | 17A0 Case 17 History
Case 17 History ---- The patient was a 62 year old male with a history of hypertension and coronary artery disease (s/p CABG in 1989). He initially presented to BJH in December of 1993 with severe necrotizing pancreatitis believed to be secondary to cholelithiasis. The patient developed multiple embolic infarcts of his kidneys, liver, spleen and bowel resulting in acute renal failure requiring hemodialysis, hepatic insufficiency and ischemic bowel which required surgical resection. The patient had a long hospital course complicated by gram positive and gram negative sepsis (requiring pressors), DIC, ARDS requiring chronic ventilator support, GI bleeding, multiple bowel resections and debridement for recurrent abdominal abscesses and bowel fistulas. The patient required a right above knee amputation for an ischemic leg. The patient also had an asystolic cardiac arrest in December of 1994. In March of 1994 the patient was noted to have severe valvular insufficiency in addition to his persistent fever and high white cell counts. Cardiologic evaluation revealed severe oxacillin resistant staph aureus endocarditis of both mitral and aortic valves believed to be related to line sepsis. The patient continued to do poorly despite broad spectrum antibiotics and he was felt to require cardiac valve surgery. However, given the patient’s dismal prognosis, it was decided to discontinue any further aggressive ventilatory support and he expired on March 31. ---- Autopsy results included multifocal septic embolic infarcts, subacute, involving right frontal lobe and basal ganglia, right occipital lobe, left and right parietal lobes, and cerebellum with local involvement of the leptomeninges.
