A 35-year-old female presented with abdominal pain, vomiting, diarrhea and high fever. She was diagnosed with septic shock due to E. coli bacteremia. Tests did not reveal the source of the infection. She was treated with antibiotics and improved. She was discharged on cefpodoxime with instructions to follow up with her primary care physician after completing the antibiotic course.

1. Admission Date: 2021-10-1 Discharge Date: 2021-10-5
Date Of Birth: 1987-14-8 Sex: F
Service: MEDICINE
Allergies: Iodine
Attending: Straus
Chief Complaint: presenting abdominal pain, vomiting, diarrhea, high fever, chills
Major Surgical Or Invasive Procedure: none
History Of Present Illness: 35 year old female with no significant past medical history presents
with 3 days of fevers and malaise. She reports her symptoms started 3 days ago and have
been gradually progressing. She has had headache, fevers, chills, night sweats, myalgias,
cough productive of green sputum, nausea/vomiting (non-bloody, up to 7x per day), diarrhea
(non-bloody, up to 5x per day). She notes generalized abdominal pain, worst in the
suprapubic region. Also decreased PO intake. No chest pain or SOB. No dysuria. No recent
travel or sick contacts. . In the ED, initial vs were: T 104.5, P 129, BP 122/74, R 20, O2 sat 96%
RA. Exam was notable for tenderness in the right and left lower quadrants, in addition to initial
examination showing cervical motion tenderness. She became progressively hypotensive and
tachycardic with systolic BP down to the 70s. She was given 6 liters of normal saline. A right
femoral central venous line was placed and levophed was initiated. OB/Gyn was consulted out
of concern for pelvic inflammatory disease. Pelvic ultrasound was negative. Her intrauterine
device was removed. OB/Gyn did not feel her examination or ultrasound findings were
consistent with pelvic inflammatory disease. Her chest X-Ray was clear. CT abd/pelvis was
also unremarkable for acute pathology. She received unasyn and doxycycline initially for
antibiotic coverage. When she clinically worsened, vanco and clindamycin were added. In
addition, she was given zofran, tylenol, and toradol. As the patient had been sexually active on
the morning of admission and her IUD was removed, she was also given plan B. She was then
admitted to the Chaplaincy for close monitoring. . On arrival to the Chaplaincy, she feels very
warm as if she is spiking a temp and complains of overall fatigue.
Past Medical History: seasonal allergies asthma carpal tunnel syndrome cholecystectomy 1-
30 gallstones
Social History: Significant for as above alcohol and cocaine abuse, tobacco use and history of
multiple assaults.
General: Alert, awake, obese Asian female, no acute distress
Lungs: Clear to auscultation bilaterally anteriorly, no wheezes, rales, ronchi
Abdomen: soft, mild tenderness to deep palpation with greatest tenderness in the suprapubic
region and LLQ, non-distended, normal bowel sounds, no rebound tenderness or guarding, no
organomegaly

2. Brief Hospital Course: The patient is a 35 year-old woman who presented with two weeks of
malaise and a three day history of worsening abdominal pain, fever, diarrhea, and vomiting.
She was admitted to the ICU for septic shock related to E coli bacteremia. She was treated
initially with Unasyn and Vancomycin empirically. However, vancomycin was discontinued once
culture data returned. The source of the Ecoli sepsis was unclear. METTY liver ultrasound was
normal; transthoracic echocardiography did not reveal vegetation; and abdominal/pelvic CT did
not show any acute intra-abdominal process. Despite low suspicion for pelvic inflammatory
disease, her intrauterine device was removed, but her urine culture and gonococcal/chlamydia
cervical sample were both negative. She also did not have purulent cervical discharge, nor
marked cervical motion tenderness. Her normal liver ultrasound and tests along with
unremarkable CT abdomen lowered the possibility of biliary source of infection. Taken
altogether, the E. coli sepsis was likely acquired as a consequence of infectious gastroenteritis,
possibly through mild ulceration of the colonic surface allowing bacterial translocation. She
became afebrile and her abdominal pain improved. Her WBC was 24 on admission and was
normal on discharge. She was seen by the ID service. She was discharged on Cefpodoxime to
finish a course of 14 days of antibiotics. She was instructed to see her PCP at the end of her
antibiotic therapy on 2021-11-17.
Discharge Medications: 1. Acetaminophen 325 mg Tablet Sig: Two (2) Tablet PO Q6H (every 6
hours) as needed for fever or pain. 2. Cefpodoxime 200 mg Tablet Sig: One (1) Tablet PO every
twelve (12) hours for 9 days: Please continue for 9 more days, ending on 8-9. Disp:*18
Tablet(s)* Refills:*0*
Discharge Diagnosis: Primary: - Septic Shock - E.Coli Bacteremia
Discharge Condition: Good. Afebrile, ambulating.
Discharge Instructions: You were admitted with low blood pressure and fevers and found to
have bacteria in your blood stream. We were unable to identify the source of your bacteria in
your blood stream; however, your symptoms have now resolved with antibiotics. Please
continue taking your home medications as prescribed. The following medication has been
added to your home regimen: - Cefpodoxime, please take until 8-9. Please follow-up with your
PCP within one week of finishing your antibiotics. Please call your doctor or return to the
hospital if you experience chest pain, shortness of breath, lightheadedness, abdominal pain,
bleeding, or fevers.
Followup Instructions: Follow-up with your PCP within one week of completeing your course of
antibiotics.
Completed By: 2021-10-5