Unexplained Direct Hyperbilirubinemia and New-Onset Shock in a 17-Year-Old Male

摘要

A 17-year-old African American male with a past medical history of depression was transferred from an outside hospital with a 3-day history of nonbilious, nonbloody vomiting and new-onset erythematous blanching macular rash on the trunk, arms, and legs. In the emergency department, the patient was tachycardic (134 beats per minute), hypertensive (142/98 mm Hg), and febrile with a temperature of 38.5°C. Four hours later, he became hypotensive (90/60 mm Hg) and remained tachycardic. Due to concerns of septic shock, blood cultures were drawn, and the patient was started on empiric antibiotic treatment. After admission to the hospital, subsequent workup demonstrated hyponatremia (135 mMol/L), direct hyperbilirubinemia (6.18 mg/dL), low lactate dehydrogenase (111 units/L), polymorphic neutrophil dominant leukocytosis (12800/mm3 ), elevated C-reactive protein (99.3 mg/L), and sterile pyuria.