K. Williams

63 M with stage IIIA colon cancer on cycle 4 of FOLFOX chemotherapy via tunneled PICC line, presented with 3 days of fevers, rigors, and mild confusion. ED vitals: T 39.3°C, HR 122, BP 102/64 (one transient reading of 88/52 on arrival, responded to 500 mL NS bolus within 20 minutes), RR 22, SpO2 96% on room air. WBC 22.6, lactate 1.8 mmol/L. Mild confusion on arrival, cleared to baseline by day 2. Peripheral blood cultures ×2: MRSA. PICC line cultures: 4/4 bottles MRSA, differential time to positivity 82 minutes — consistent with CLABSI. PICC removed on admission. No vasopressors at any point. Repeat lactate 1.4 at hour 4. BP stable after initial bolus through discharge. IV vancomycin started. Repeat cultures day 2: negative. TEE: no vegetations. Assessment: MRSA catheter-related bloodstream infection (CLABSI); sepsis with encephalopathy. Septic shock documented by admitting physician based on transient hypotensive episode on arrival.