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 Month: Education of the Pathologist. Arch Intern Med. 1999;159(9):907–908. doi:10.1001/archinte.159.9.907
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