Case presentation A 58-year-old woman presented to the emergency department (ED) with hypovolemic shock and diffuse, watery, and non-bloody diarrhea. Physical examination and laboratory findings Vitals: Blood pressure- 60/40 mmHg, HR- 116 bpm, temperature - 35.9 degrees Metabolic acidosis of pH 6.8 Mild leukocytosis- 13.3 k/UL Critically high potassium- 7.5 mmol/L Critically low hemoglobin- 5.9 g/dl Severe coagulopathy- Pt time 42.2 seconds Signs of multiple organ damage Blood culture - Negative X-ray and CT findings Chronic inflammatory changes in the cecum and ascending colon Mild edema in the mesentery Fluid in peritoneum Several calcified lymph nodes and diffuse hepatic steatosis No internal hemorrhage Medical history History of persistent fever, a working diagnosis of seronegative rheumatoid arthritis for seven years.
She was taking several immunosuppressive and…
