Reactions 1831, p232 - 21 Nov 2020

Norepinephrine

Lack of efficacy: case report

A 70-year-old man experienced lack of efficacy following treatment with norepinephrine for septic shock.

The man presented with complaints of malaise, fever with chills and shortness of breath evolving for 6h as well as a worsened

lumbar pain. His medical history was significant for chronic lumbar pain, permanent atrial fibrillation and chronic alcohol

consumption. He had several episodes of acute complicated pancreatitis in the past. At the age of 57 years, he had undergone a

partial pancreatectomy with splenectomy for a complicated pancreatic pseudocyst. His vaccination status was not up-to-date. He

received a single empirical dose of ceftriaxone in the prehospital setting due to the fever and his asplenic condition. Shortly after his

arrival in the emergency department, blood cultures were drawn and empirical treatment with piperacillin/tazobactam for septic

shock of unknown origin was administered. Despite volume resuscitation, norepinephrine initiation [noradrenaline; dosage and

route not stated] and administration of unspecified antibiotics, he rapidly developed a severe vasoplegic shock and was transferred

to the ICU. On day 1, he showed a severely depressed cardiac index, despite optimal volume resuscitation. Septic cardiomyopathy

was suspected and dobutamine was initiated. The clinical course was associated with acute kidney injury and ICU delirium. On

day 2, a dark purple spot was detected on his left forearm, which was reported by his spouse to be a 4-day-old cat scratch. Swelling

was absent and the lesion showed neither signs of cellulitis nor lymphadenopathy. On day 2, the vasopressor requirements

decreased, and shock resolved on day 5. Laboratory findings evolved towards a leukemoid reaction with the highest count of white

blood cells on day 4. The patient also developed severe thrombocytopenia on day 4. Acute kidney injury, delirium and coagulation

abnormalities were resolved with supportive measures [details not stated].

The man was discharged from ICU on day 8 and he was discharged for rehabilitation on day 26. It was found that he had septic

shock due to Capnocytophaga canis after a cat scratch.

Donner V, et al. Septic shock caused by Capnocytophaga canis after a cat scratch. European Journal of Clinical Microbiology and Infectious Diseases 39: 1993-1995, No. 10,

2020. Available from: URL: http://doi.org/10.1007/s10096-020-03922-8

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