Febrile Shock is not Always Septic
A 47-year-old woman with a history of poorly treated tachyarrhythmia was admitted to the intensive care unit (ICU) with hemodynamic instability of uncertain etiology. Two days earlier the patient presented at the Emergency Department of a rural hospital with febrile diarrhea of recent onset. The ECG showed rapid atrial fibrillation. She was initially admitted to the Internal Medicine ward and within 24 hours she developed high fever with signs of circulatory collapse, acute pulmonary edema and was subsequently intubated with a working diagnosis of septic shock. At the time of the ICU admission, the patient had already developed multi-organ dysfunction with renal insufficiency and liver failure. Right heart catheterization revealed a profile of high cardiac output with very low systemic vascular resistance. A high index of clinical suspicion led to the diagnosis of thyroid storm. Despite prompt initiation of the appropriate therapy and rigorous supportive care the patient died 9 days later due to disseminated intravascular coagulation and acute liver failure.
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