Crtical Care and Shock Journal

Salmonella septic shock associated with DIC and thrombocytopenia in a young adult



Background: This case report presents the clinical course and management of a 27-year-old male patient admitted with symptoms of fever, fatigue, diarrhea, and mild pallor. The patient exhibited signs of septic shock, including hypotension, tachypnea, and elevated inflammatory markers.

Case presentation: Initial diagnosis revealed sepsis-associated thrombocytopenia and further investigations were conducted to exclude other infectious causes. The patient had a recent travel history to India. Blood culture results confirmed Salmonella infection, with the identified strain being resistant to fluoroquinolones but susceptible to ceftriaxone and meropenem. Imaging studies revealed findings consistent with typhlitis, and the patient exhibited pancytopenia and neutropenia, indicating immune compromise.

Management and outcome: The patient received intravenous fluids and empirical antibiotics after culture collection and closely monitoring laboratory parameters. Norepinephrine administration was initiated to stabilize blood pressure, and intravenous steroids were given to reduce inflammation. Apheresis platelets were given due to low critical platelet count and associated lower gastrointestinal bleeding. Over the course of ten days, the patient showed positive progress, with decreased fever, cessation of diarrhea, and reduced inflammatory markers. Norepinephrine support was gradually tapered, and oral medications were initiated. Regular follow-up appointments were recommended for monitoring and adjustment of the treatment plan.

Conclusion: This case highlights the challenges and multidisciplinary approach involved in managing septic shock associated with disseminated intravascular coagulation and thrombocytopenia, which was complicated by neutropenic enterocolitis (typhlitis). Prompt diagnosis, appropriate antibiotic therapy, supportive care, and close monitoring of laboratory parameters were crucial in optimizing patient outcomes. Further research and clinical studies are warranted to improve understanding and management of this complex condition.


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June 2024, Volume 27 Number 3
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