D. Nakamura

71 M with type 2 diabetes and recent ERCP for choledocholithiasis (2 weeks prior) presented with 2 days of worsening right upper quadrant pain, fever, and jaundice consistent with Charcot's triad. ED vitals: T 38.9°C, HR 112, BP 92/58, RR 20, SpO2 97% on room air. Lactate 3.1 mmol/L. Total bilirubin 4.2, direct bilirubin 3.1, ALP 340 U/L. WBC 18.4. Creatinine 2.1 mg/dL (documented baseline 0.8 from pre-procedure labs 2 weeks prior). Blood cultures ×2 — both positive for Klebsiella pneumoniae. Emergent ERCP with stone extraction and biliary stent placement day 1. IV piperacillin-tazobactam initiated, narrowed per sensitivities. Creatinine trended: 2.1 → 1.8 → 1.3 → 0.9. Urine output maintained >0.5 mL/kg/hr throughout. Assessment: Klebsiella pneumoniae sepsis secondary to acute obstructive cholangitis; acute kidney injury (KDIGO stage 2), resolved.