The perils of penile enhancement: case report of a fulminant penile infection

Abstract Background Penile enhancement with injectable agents is a rising trend and yet has received little scientific attention despite the potential for serious complications. These include cosmetic, functional and systemic complications that may require complex penile reconstructive surgery. We report a case of delayed severe infection following penile filler insertion leading to multi-organ failure and intensive care support. Case presentation A 31-year-old man presented with fevers and progressive pain and swelling of the penile shaft, 3 days after unprotected sexual intercourse. The patient received subcutaneous hyaluronic filler injections at a cosmetic clinic for penile enlargement two months prior to presentation. Relevant social history include polysubstance abuse and multiple sexual partners. Physical examination revealed gross penile oedema and erythema, with a ventral curvature of the penile shaft and a superficial abrasion on the distal ventral penile shaft. Within 24 h the patient developed septic shock with anuria, hypotension and fevers to 40 °C, requiring transfer to the Intensive Care Unit (ICU) for vasopressor and inotropic support. Intraoperative penile exploration revealed multiple pus stained fillers which were drained and grew Streptococcus Pyogenes on cultures. There was no abscess or evidence of necrotising fasciitis intraoperatively. The patient improved with intravenous antibiotics and was stepped down from the ICU after four days and discharged on day eight. One month post admission there was significant superficial skin loss to both ventral and lateral aspect of the penis, with healthy granulation tissue at the base. The patient opted for conservative management with regular dressings. He reported normal sexual and urinary function three months post admission. Conclusion This is the first published case of sepsis from a penile infection in the context of hyaluronic acid penile fillers. In an era of escalating demand for penile cosmetic procedures, there is an increasing need for early recognition and appropriate management of penile filler infections. We report an unusual case of a localised penile infection rapidly progressing to sepsis with multi-organ failure requiring intensive care support. The case demonstrates early surgical intervention with targeted antimicrobials can result in successful eradication of infection, with satisfactory cosmetic and functional outcomes for patients.

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Rescue stem cell allograft in intensive care unit patients during septic shock with multi-organ failure

Journal of Critical Care ◽

10.1016/j.jcrc.2019.07.002 ◽

2019 ◽

Vol 54 ◽

pp. 122-124

Author(s):

Perrine Leprêtre ◽

Thomas Clavier ◽

Anne-Lise Ménard ◽

Steven Grange ◽

Christophe Girault ◽

...

Keyword(s):

Intensive Care Unit ◽

Septic Shock ◽

Stem Cell ◽

Intensive Care ◽

Organ Failure ◽

Multi Organ Failure

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Mechanistic Insights into Cell-free Hemoglobin-induced Injury During Septic Shock

AJP Heart and Circulatory Physiology ◽

10.1152/ajpheart.00092.2021 ◽

2021 ◽

Author(s):

Jeffrey Wang ◽

Willard N. Applefeld ◽

Junfeng Sun ◽

Steven B. Solomon ◽

Jing Feng ◽

...

Keyword(s):

Septic Shock ◽

Organ Failure ◽

Free Hemoglobin ◽

Multi Organ Failure ◽

Ventricular Afterload ◽

Cytokine Levels ◽

Pulmonary Arterial ◽

Lactate Levels ◽

To Receive ◽

Care Support

Rationale:Cell-free hemoglobin (CFH) levels are elevated in septic shock and higher in non-survivors. Whether CFH is only a marker of sepsis severity or is involved in pathogenesis is unknown. Objective:To investigate whether CFH worsens sepsis-associated injuries and to determine potential mechanisms of harm. Methods&Results:Fifty-one, 10-12kg purpose-bred beagles were randomized to receive Staphylococcus aureus intrapulmonary challenges or saline followed by CFH infusions (oxyhemoglobin >80%) or placebo. Animals received antibiotics, and intensive care-support for 96h. CFH significantly increased mean pulmonary arterial pressures and right ventricular afterload in both septic and non-septic animals, effects that were significantly greater in non-survivors. These findings are consistent with CFH-associated nitric oxide (NO) scavenging and were associated with significantly depressed cardiac function, and worsened shock, lactate levels, metabolic acidosis and multi-organ failure. In septic animals only, CFH administration significantly increased mean alveolar-arterial oxygenation gradients, also to a significantly greater degree in non-survivors. CFH associated iron levels were significantly suppressed in infected animals, suggesting that bacterial iron uptake worsened the pneumonia. Notably, cytokine levels were similar in survivors and non-survivors and not predictive of outcome. Conclusions:In the absence and presence of infection, CFH infusions resulted in pulmonary hypertension, cardiogenic shock and multi-organ failure, likely through NO scavenging. In the presence of infection alone, CFH infusions worsened oxygen exchange and lung injury, presumably by supplying iron that promoted bacterial growth. CFH elevation, a known consequence of clinical septic shock, adversely impacts sepsis outcomes through more than one mechanism and is a biologically plausible, non-antibiotic, non-cytokine target for therapeutic intervention.

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The Challenges of Morbid Obesity and Multi-Organ Failure: A Case Study of Early Mobility in the Intensive Care Unit

Journal of Acute Care Physical Therapy ◽

10.1097/01592394-201001010-00009 ◽

2010 ◽

Vol 1 (1) ◽

pp. 33

Author(s):

Radha Korupolu ◽

Jennifer Zanni ◽

Martha Butler ◽

Dale Needham

Keyword(s):

Intensive Care Unit ◽

Morbid Obesity ◽

Intensive Care ◽

Organ Failure ◽

Early Mobility ◽

Multi Organ Failure

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Intensive care management of organophosphorus poisoning patients: an experience from tertiary care centre

International Journal of Advances in Medicine ◽

10.18203/2349-3933.ijam20180957 ◽

2018 ◽

Vol 5 (2) ◽

pp. 257 ◽

Cited By ~ 1

Author(s):

Syed Nazima Nazima ◽

Yasir Bashir ◽

Shakeeb Nabi ◽

Nusrat Bashir

Keyword(s):

Intensive Care ◽

Mortality Rate ◽

Care Management ◽

Early Recognition ◽

Tertiary Care ◽

Tertiary Care Centre ◽

Intensive Care Management ◽

Medical College ◽

Appropriate Treatment ◽

Care Support

Background: Organophosphate (OP) insectide poisoning results from occupational, accidental and intentional exposure. The mortality rate of OP poisoning is high. Early diagnosis and appropriate treatment is often lifesaving.Methods: This study “Intensive care management of organophosphorous poisoning in Govt. medical college Srinagar (Sgr) hospital was a prospective one and was conducted over a period of two. All the patients with a provisional diagnosis of Organophosphorous poisoning who reported to the medical casualty and intensive care unit of SMHS hospital Sgr were included in this study.Results: Out of a total of 1258 Organophosphorous poisoning cases, males were (34.5%) and females were (65.5%). Suicidal mode of poisoning was most common in our patients and constituted 63.20%. Out of 254 Organophosphorous poisoned patients admitted in ICU, 184 survived and 70 expired. Therefore, mortality rate for Organophosphorous poisoned patients who needed mechanical ventilation was 27.55.Conclusions: OP poisoning is a serious problem in Kashmir Valley. Efforts should be directed towards rapid diagnosis and management of this condition. Additionally, close intensive monitoring of these patients for early recognition of respiratory failure which is one of the serious complication of OP poisoning with intensive care support will help in decreasing the mortality rate in these patients.

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Thyroid Storm Presenting as Intra-abdominal Sepsis with Multi-organ Failure Requiring Intensive Care

Anaesthesia and Intensive Care ◽

10.1177/0310057x0903700609 ◽

2009 ◽

Vol 37 (6) ◽

pp. 1005-1007 ◽

Cited By ~ 6

Author(s):

M. Karanikolas ◽

D. Velissaris ◽

V. Karamouzos ◽

K. S. Filos

Keyword(s):

Intensive Care ◽

Organ Failure ◽

Abdominal Sepsis ◽

Thyroid Storm ◽

Multi Organ Failure

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Association Between Weekend and Holiday Admission with Pneumonia and Mortality in a Tertiary Center in Portugal: A Cross-Sectional Study

Acta Médica Portuguesa ◽

10.20344/amp.8029 ◽

2017 ◽

Vol 30 (5) ◽

pp. 361 ◽

Cited By ~ 3

Author(s):

Margarida Barreto Cortes ◽

Samuel Raimundo Fernandes ◽

Patricia Aranha ◽

Luís Brito Avô ◽

Luís Menezes Falcão

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Length Of Stay ◽

Organ Failure ◽

Bacterial Pneumonia ◽

Hospital Admissions ◽

Early Recognition ◽

Cross Sectional ◽

Tertiary Center ◽

The Impact

Introduction: Acute bacterial pneumonia is a common and potentially fatal disease where early recognition and treatment are crucial. Increasing medical literature suggests worse outcomes in patients admitted for medical and surgical conditions during the weekend. Little is known about this effect in patients with acute bacterial pneumonia.Objective: The aim of this study was to evaluate the impact of weekend and holiday hospital admission on the outcomes of acute bacterial pneumonia.Material and Methods: Retrospective analysis of adult patients (> 18 years) with acute bacterial pneumonia collected from a tertiary referral center database. Length of stay, total cost, admission to intensive care unit, development of sepsis and organ failure, and mortality were compared between patients admitted on a weekday and patients admitted during a weekend or holiday.Results: We analyzed 53 854 hospital admissions from 42 512 patients (median age 84.0 years, range 18 - 118 years), corresponding to 30 554 admissions during weekdays, 21 222 at weekends and 2078 during public holidays. Weekend and holiday admission was not associated with increased costs, length of stay, intensive care unit admission, development of sepsis, organ failure, and mortality.Conclusion: A weekend/holiday effect in acute bacterial pneumonia was not evident in our series.

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Concomitant use of veno-arterial extracorporeal membrane oxygenation and Impella in the intensive care unit: a case report of fulminant myocarditis with multi-organ failure

Anestezjologia Intensywna Terapia ◽

10.5114/ait.2020.93233 ◽

2020 ◽

Vol 52 (1) ◽

pp. 63-66

Author(s):

Ryszard Gawda ◽

Maciej Marszalski ◽

Jerzy Sacha ◽

Maciej Gawor ◽

Jacek Hobot ◽

...

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Case Report ◽

Extracorporeal Membrane Oxygenation ◽

Organ Failure ◽

Fulminant Myocarditis ◽

Membrane Oxygenation ◽

Multi Organ Failure

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Exertional Heatstroke, Asesmen Cepat Dan Penatalaksanaan Tepat: Laporan Kasus

Jurnal Widya Medika ◽

10.33508/jwm.v5i1.2001 ◽

2019 ◽

Vol 5 (1) ◽

pp. 74-90

Author(s):

Melinda ◽

Filipus Michael Yofrido Yofrido ◽

Philia Setiawan

Keyword(s):

Organ Failure ◽

Core Body Temperature ◽

Kidney Injury ◽

Pancreatic Injury ◽

Colloid Solution ◽

Blood Component ◽

Systemic Complications ◽

Central Nervous System Dysfunction ◽

Multi Organ Failure ◽

Cold Extremity

Heatstroke is the most severe heat illness which homeostatic thermoregulatory mechanism is failed, characterized by an elevation of the core body temperature above 40 oC, central nervous system dysfunction, and possible multi-organ failure. Heatstroke is the third leading cause of death among athletes. Exertional heatstroke (EHS) is exercise-induced; usually affects young healthy people during strenuous physical activity and have not acclimatized to environmental heat stress. Frequently encountered complications include encephalopathy, acute respiratory distress syndrome, myocardial injury, acute kidney injury, hypoglycemia, intestinal ishemia or infarction, pancreatic injury, rhabdomyolysis, disseminated intravascular coagulation (DIC), hypocalcemia, lactic acidosis, and hepatic failure. Immediate cooling is the cornerstone of treatment which evaporative cooling is preferred. Aspiration and seizure are common; airway management, oxygenation, and ventilation have to be adequately maintained. Crystalloid-fluid resuscitation is essential, averaging 1200 mL in first 4 hours. Systemic complications of heatstroke should be well-managed to prevent worse outcome. A case of 32-years-old man with no significant medical history was brought to emergency department after collapsing while running into the 20-kilometres marathon. He was unresponsive (GCS E1V2M1), had serial generalized seizure and hematemesis-melena. On primary survey, the patient was shocked (BP 67/24 mmHg, HR 165 bpm, cold extremity), tachypnea (41/min), hyperthermia (40.5oC rectally), SpO2 95% on simple mask 10 L/min. His laboratory results showed full-blown complications of heatstroke. Immediate rehydration therapy using saline solution and colloid solution intravenously was started, followed with blood or blood component transfusion. Tracheal intubation and mechanical ventilation were performed. During the intensive treatment, he became fully conscious and was extubated on hospital day 7. He was hemodynamically stable without any support, but developed multi-organ failure. Unfortunately, on twentieth day, he was cardiac arrest during hemodialysis and died four days later.

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