A confirmed case of type I diabetes mellitus who had subcutaneous insulin infusion. She suddenly developed fever, low blood pressure, abdominal pain, and erythroderma. The injection site was not cleaned with iodine solution and she did not change the injection site. There were abscesses developed at the site of injection but they were not cultured to rule out the cause of infection.

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The patient was an 80-year-old female who 10 days previously had had a cystocele repair performed. At the time of the hospital admission, a urine culture was obtained and revealed >100,000 CFU/ml of an Escherichia coli strain that was susceptible to all antimicrobial agents against which it was tested. Postoperatively, she began a 7-day course of oral cephalexin. She was discharged after an uneventful postoperative course of 3 days. Ten days postoperatively, she presented with a 3-day history of diarrhea. The patient noted multiple watery, loose stools without blood, crampy abdominal pain, and vomiting. She presented with a temperature of 38.2 degrees C, pulse rate of 90/min, respiration rate of 20/min, and blood pressure of 116/53mm Hg. Her white blood cell count was normal, but a large number (53%) of immature polymorphonuclear cells were seen. Physical examination, electrolytes, liver enzymes, and lipase were all within normal limits. Cultures for Salmonella, Shigella, Yersinia,…

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Chapter 21, Problem 2CAE

Summary Introduction

Case summary:

A confirmed case of type I diabetes mellitus who had subcutaneous insulin infusion. She suddenly developed fever, low blood pressure, abdominal pain, and erythroderma. The injection site was not cleaned with iodine solution and she did not change the injection site. There were abscesses developed at the site of injection but they were not cultured to rule out the cause of infection.

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The patient was an 80-year-old female who 10 days previously had had a cystocele repair performed. At the time of the hospital admission, a urine culture was obtained and revealed >100,000 CFU/ml of an Escherichia coli strain that was susceptible to all antimicrobial agents against which it was tested. Postoperatively, she began a 7-day course of oral cephalexin. She was discharged after an uneventful postoperative course of 3 days. Ten days postoperatively, she presented with a 3-day history of diarrhea. The patient noted multiple watery, loose stools without blood, crampy abdominal pain, and vomiting. She presented with a temperature of 38.2 degrees C, pulse rate of 90/min, respiration rate of 20/min, and blood pressure of 116/53mm Hg. Her white blood cell count was normal, but a large number (53%) of immature polymorphonuclear cells were seen. Physical examination, electrolytes, liver enzymes, and lipase were all within normal limits. Cultures for Salmonella, Shigella, Yersinia,…

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