Septic Shock After Suprapubic Catheter Placement in a Patient With Advanced Multiple System Atrophy.

Multiple system atrophy (MSA) is a progressive neurodegenerative synucleinopathy characterized by autonomic dysfunction, including significant genitourinary involvement that predisposes patients to urinary retention and infection. We present the case of an 81-year-old man with advanced MSA and chronic urinary retention who developed septic shock shortly after elective suprapubic catheter placement. His hospital course was complicated by emphysematous pyelitis, acute kidney injury, and hemodynamic instability requiring vasopressor support. This case highlights the increased risk of severe infectious complications following urologic instrumentation in patients with MSA and underscores the importance of anticipatory perioperative management in this high-risk population.