A 47-YEAR-OLD man was admitted to the hospital with complaints of leg swelling and shortness of breath. His medical history included chronic alcohol abuse and diabetes. Serologic testing indicated hepatitis C infection. Evaluation also showed probable cirrhosis and spontaneous bacterial peritonitis due to culture-proven infection with Escherichia coli. Antibiotic therapy was administered. While in the hospital, the patient fell from his bed and sustained a head injury on the sixth hospital day. He was conscious and responsive when discovered on the floor near his bed, but within an hour he required intubation after a sudden deterioration in mental status. Neuroimaging showed a subdural hematoma with midline shift. There was transient clinical improvement, but fever, increasing leukocytosis, and a gradual decline in his condition ensued and he died on hospital day 14.
Hanzlick R, McKenney JK, Autopsy Committee of the College of American Pathologists. Case of the MonthEducation of the Pathologist. Arch Intern Med. 1999;159(9):907-908. doi:10.1001/archinte.159.9.907