Bilateral adrenal hemorrhage

Excerpt

A 42-year-old woman with history of B cell acute lymphoblastic leukemia, currently receiving chemotherapy, was admitted to the hospital with altered mental status. She was found to be hypotensive and in acute hypercapnic respiratory failure requiring mechanical ventilation. She was treated with broad-spectrum antibiotics, fluid resuscitation, vasopressor support, and stress dose steroids but continued to be hypotensive with a lactate of 16 mmol/L. A computed tomography scan of the abdomen revealed bilateral stranding around the adrenal glands indicative of bilateral adrenal hemorrhage (Fig. 1). The patient was started on a corticosteroid infusion. Despite these interventions the patient rapidly progressed to multi-organ failure and died. Blood cultures came back positive for methicillin-resistant Staphylococcus aureus (MRSA).

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