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A 43-year-old man presented to the hospital with septic shock. Eight weeks prior, he had experienced recurrent gastric variceal bleeding (figure 1), treated initially with cyanoacrylate glue injection. Abdominal CT scan suggested features of chronic liver disease, with non-alcoholic fatty liver disease being the presumed aetiology. Despite endoscopic therapy, he had further variceal haemorrhage, and was treated successfully with insertion of a transjugular intrahepatic portosystemic stent shunt (TIPSS) (covered stent). Other past medical history included ulcerative colitis, antiphospholipid syndrome (treated with warfarin) and splenectomy.
On physical examination, there was no obvious source of infection. Laboratory investigations demonstrated a white blood cell count of 18.4×109/l, haemoglobin of 106 g/L, C-reactive protein of 195 mg/L and international …
Contributors All authors were involved in the case of this patient and contributed to writing this case.
Funding BHM is the recipient of an MRC Clinical Research Training Fellowship (grant reference: MR/R000875/1). The Division of Integrative Systems Medicine and Digestive Disease receives financial support from the National Institute of Health Research (NIHR) Imperial Biomedical Research Centre (BRC) based at Imperial College Healthcare NHS Trust and Imperial College London.
Competing interests None declared.
Provenance and peer review Not commissioned; externally peer reviewed.
Patient consent for publication Obtained.
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