Fever with multiple organ failure: not always sepsis

摘要

We present the case of a 52-year-old female admitted with fever and multiple organ failure, initially treated for presumed sepsis. However, the combination of multiple organ failure, hyperthermia and vascular instability raised the suspicion of a phaeochromocytoma multisystem crisis. An emergency abdominal ultrasound in the intensive care unit disclosed a large tumour of the right adrenal. Despite specific medical treatment for the presumed adrenal emergency and multiple organ failure, the patient succumbed. Postmortem examination verified the diagnosis of phaeochromocytoma. Patients with phaeochromocytoma, adrenal insufficiency, pituitary apoplexy or withdrawal of corticosteroid therapy may present as multiple organ failure syndromes to the emergency department. Phaeochromocytoma multisystem crisis (PMC) is rare, however it represents the most dramatic and fulminant clinical expression of the tumour. Its main features are multiple organ failure, hyperthermia, encephalopathy and vascular instability, usually happening unpredictably.