A case of severe sepsis and disseminated intravascular coagulation induced by a ureteral stone

Abstract

We report a case of severe sepsis with disseminated intravascular coagulation (DIC) induced by a ureteral stone. An 85-year-old woman was admitted to hospital with fever. Urinary tract infection was suspected and antibiotic therapy was started. She subsequently developed a state of shock the next day, and was transferred to our hospital. Her laboratory data upon admission were already showing DIC and multiple organ dysfunction syndrome (MODS). Furthermore, her serum endotoxin level was high (15.5 pg·ml⁻¹). Abdominal CT scanning showed a left ureteral stone and left hydronephrosis. The patient died on the 2nd day in hospital. Drainage of urine by a transurethral catheter, endotoxin removal therapy, and continuous hemodiafiltration were not able to improve her condition. Escherichia coli was isolated from both her blood and urine. We conclude that age, procrastination over systemic inflammatory response syndrome (SIRS), and acceleration of endotoxin release from gram-negative bacteria by antibiotics were the critical factors in this case.