title: Bilateral adrenal hemorrhage in the background of Escherichia coli sepsis: a case report.
abstract: BACKGROUND
  Sepsis is a syndrome of life-threatening organ dysfunction caused by a dysregulated host response to infection. It can have devastating consequences, including bilateral adrenal hemorrhage, particularly in patients at high thrombotic risk, such as those with antiphospholipid syndrome and those on long-term anticoagulation.
  
  
  METHODS
  A 49-year-old white woman re-presented to hospital with a history suggestive of sepsis. She had a medical background of primary antiphospholipid syndrome on lifelong warfarin. Ten days prior to this presentation, she had been hospitalized following Escherichia coli bacteremia, commenced on intravenous antibiotics, and discharged 2 days later with a prescribed 5-day course of oral amoxicillin. On readmission, she had ongoing fever, myalgia, malaise, and hypotension. Investigations revealed anemia with thrombocytopenia, hyponatremia, and acute-on-chronic kidney injury. Despite treatment for urosepsis, she became tachypneic, clammy, light-headed, drowsy, and hypothermic. Computed tomography revealed bilateral adrenal hemorrhage, and biochemical examination confirmed hypoadrenalism. Following discharge, she had persistent renal and hepatic injury lasting 3 months.
  
  
  CONCLUSIONS
  Early identification, intensive monitoring, and aggressive support may reduce the acquired thrombotic risk and avoid potentially life-threatening outcomes of sepsis.
authors.affiliation: St Helier Hospital, Wrythe Lane, Carshalton, SM5 1AA, UK. j.khwaja@nhs.net.
authors.forename: Jahanzaib
authors.initials: J
authors.lastname: Khwaja
mesh_terms: D015746:Abdominal Pain / Q000209:etiology; D000307:Adrenal Gland Diseases / Q000000981:diagnostic imaging* / Q000628:therapy*; D000311:Adrenal Glands / Q000000981:diagnostic imaging* / Q000473:pathology; D000309:Adrenal Insufficiency / Q000000981:diagnostic imaging*; D000900:Anti-Bacterial Agents / Q000008:administration & dosage; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage; D016736:Antiphospholipid Syndrome / Q000150:complications; D003967:Diarrhea / Q000209:etiology; D004926:Escherichia coli; D005260:Female; D006470:Hemorrhage / Q000000981:diagnostic imaging* / Q000628:therapy*; D006801:Humans; D006854:Hydrocortisone / Q000008:administration & dosage; D008875:Middle Aged; D018805:Sepsis / Q000175:diagnosis* / Q000188:drug therapy; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014839:Vomiting / Q000209:etiology; D014859:Warfarin / Q000009:adverse effects
chemical_list: D000900:Anti-Bacterial Agents; D000893:Anti-Inflammatory Agents; D014859:Warfarin; D006854:Hydrocortisone
keywords: Anticoagulation; Antiphospholipid syndrome; Bilateral adrenal hemorrhage; Sepsis; Thrombosis