Dr Saicharan Kulkarni MD

  Clinical Problem Representation: A late 60s male with a history of diabetes and CABG on DAPT, presents with acute onset of fever, vomiting, and diarrhea, now complicated by AKI, elevated cardiac markers, and sepsis indicated by high procalcitonin. Imaging shows pulmonary and gastrointestinal involvement with systemic inflammatory response, currently requiring intensive support including mechanical ventilation and vasopressors. Most Likely Differential Diagnosis: Sepsis secondary to gastrointestinal source : The patient's presentation with fever, elevated procalcitonin, and systemic inflammatory response, alongside gastrointestinal symptoms and findings of esophageal ulcers and erosive gastritis on endoscopy, strongly suggest a septic process originating from a gastrointestinal source. The presence of blood in the stomach and duodenum could indicate significant mucosal damage leading to translocation of bacteria. Acute gastrointestinal bleeding with hypovolemic shock : The finding