An Autopsy Case of Overwhelming Sepsis with Hypoglycemia in a Patient with Alcoholic Liver Cirrhosis

Abstract

A 46-year-old man, unconscious, was admitted to our hospitalas an emergency case. He was known to have liver disease due to excessive alcohol intake. He had fallen while riding a motorcycle one week before admission. On arrival, he was comatose and in a state of shock. Petechiae and subcutaneous bleeding were observed on his trunk and extremities. His left upper and lower extremities were remarkably swollen, and a discolored, elevated, hard mass was found on the outer side of the left ankle joint. He was diagnosed as having disseminated intravascular coagulation complicated by renal and liver failure. Hypoglycemia(plasma glucose level 29 mg/dl), hyperammonemia and severe metabolic acidosis were found. He was treated with controlled ventilation, plasma expanders, blood transfusion, antibiotics, dopamine, noradrenaline, nafamostate gabexate and hypertonic glucose. Despite this intensive treatment, he died of irreversible shock 20 hours after admission. Postmortem examination revealed small vegetation in the aortic Valve and microabscesses in the kidney, heart, thyroid gland, and retroperitoneal adipose tissues. These findings suggest that he had developed sepsis stemming from cellulitis further to alcoholic liver cirrhosis. It is considered imperative that physicians consider the possibility of hypoglycemia in all patients with multiorgan failure.