[Sepsis in a woman with severe portosystemic encephalopathy. An uncommon complication of drug therapy].

HISTORY: A 60-year-old woman was referred to our hospital, because she was unarousable. She was known to have an impaired liver function due to long-lasting alkohol abuse. Third-party medical history did not explain the patient's condition.

TREATMENT AND COURSE: The history and laboratory findings suggested hepatic coma, therefore treatment with ornithin-aspartat, rifaximin, lactulose and antibiotics was started. Lactate concentration indicated severe hypoxic damage. The clinical examinations and circulatory parameters lead to the diagnosis of sepsis, which was suspected to be caused by spontaneous bacterial peritonitis. Computed tomography of the abomen demonstrated colitis but no other pathologic intestinal finding. Inspite of intensive therapy with antibiotics, fluids and catecholamines the patient died 3 days after admission. Autopsy revealed the cause of sepsis: a tablet, swallowed with its blister package had led to a perforation of the terminal ileum.

CONCLUSION

Apart from the most cause of peritonitis in patients with liver cirrhosis - the spontaneous bacterial peritonitis - a secondary cause must also be taken into account as a reason for sepsis. A well prepared history could possibly show the direction for detection of the cause.