Fig. 39.

A 52-year-old female patient with known long-standing chronic renal failure on hemodialysis, multiple myeloma, and end-stage gastric adenocarcinoma recently underwent intense chemotherapy and now presented with high fever, severe abdominal pain, hypotension, and lethargy. Clinical examination revealed severe abdominal tenderness and mild jaundice. Laboratory studies revealed an abrupt increase in liver function tests. Findings were suggestive of septic shock, and blood cultures were also drawn. An emergent thoracoabdominal CT was performed to evaluate the potential source of infection. Axial plane postcontrast abdominal CT showed brisk enhancement in adrenal glands (arrowheads), suggesting severe metabolic stress. Also noted were extensive hypodense areas throughout the liver parenchyma (white asterisks), which were thought to represent parenchymal infarcts or perfusion defects. Also noted were globally infarcted spleen (black asterisk). The patient was immediately transferred to ICU; however, she expired 6 h after this CT scan. Blood cultures grew Klebsiella pneumoniae