An Unusual Case of Multiorgan Failure

Eva Nourbakhsh, MD; Kenneth M. Nugent, MD; Rishi Raj, MD


March 10, 2015

Editor's Note: The Case Challenge series includes difficult-to-diagnose conditions, some of which are not frequently encountered by most clinicians but are nonetheless important to accurately recognize. Test your diagnostic and treatment skills using the following patient scenario and corresponding questions. If you have a case you would like to suggest for a future Case Challenge, please contact us.


A 70-year-old woman was recently treated in the hospital for a right hip fracture, weakness, and chronic atrial fibrillation with a rapid ventricular response. Two days after she was discharged to a long-term care facility, she is readmitted for urinary retention and recurrent tachycardia. In addition, she complains of generalized weakness and midline lower abdominal pain. She denies any history of urinary retention as well as experiencing any fever, dysuria, hematuria, vomiting, trouble breathing, or chest pain in association with this presentation. Her medical and surgical history includes a stroke with left hemiparesis, hypertension, atrial fibrillation, epilepsy, and hemiarthroplasty; she is nonambulatory secondary to the stroke. Her medications include atorvastatin, enoxaparin, levetiracetam, metoprolol, omeprazole, and warfarin (7.5 mg daily).


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