Urosepsis as differential diagnosis of septic shock: three case reports

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  • 診断に難渋した急性腎盂腎炎による敗血症性ショックの３例

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Abstract

The first patient was a 68-year-old woman with urinary calculus. She experienced sudden chest pain and dyspnea. Hypotension with hypokinesis was observed in the echocardiogram along with increased myocardial enzyme. We suspected cardiogenic shock due to acute myocardial infarction, but coronary angiography demonstrated no coronary stenosis. The patient's vital signs improved with urinary drainage. Our diagnosis was takotsubo cardiomyopathy as a result of urosepsis. The second patient was a 63-year-old woman with abdominal pain, diarrhea and vomiting. Hypotension, drowsiness, ascites and intestinal edema in computed tomography were observed. While we suspected panperitonitis due to intestinal perforation, our diagnosis was urosepsis from acute pyelonephritis and kidney abscess based on necrotomy findings. The final patient was an 82-year-old woman with drowsiness and abdominal pain. Hypotension and dilatation of the right renal pelvis, and intrahepatic bile duct with choledocholith were observed in CT. We suspected septic shock due to pyogenic cholangitis based on the abdominal symptoms, but we diagnosed the case as urosepsis with pyelonephritis based on culture findings. In all cases, fatal diseases were suspected by the symptoms and findings, while urosepsis was not strongly suspected. In the differential diagnosis of septic shock, even if symptoms and findings do not strongly indicate urosepsis, we should consider drainage of the urinary tract for diagnosis and treatment.

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