A Bleeding Conundrum: Intraventricular Hemorrhage and Gross Hematuria Secondary to Pneumosepsis

Abstract

We report the case of a 67-year-old Saudi man with multiple comorbidities, including type 2 diabetes mellitus, hypertension, ischemic heart disease, and chronic kidney disease, who presented with progressive shortness of breath, altered mental status, and fever. His symptoms began five days prior with productive cough, pleuritic chest discomfort, and generalized body aches, initially managed at home. On presentation, he was hypotensive, tachycardic, hypoxemic, and disoriented, with signs of respiratory distress and new ecchymoses. Laboratory evaluation revealed leukocytosis, elevated inflammatory markers, acute kidney injury, and coagulopathy. Chest radiography demonstrated new bilateral multifocal pneumonic patches compared with prior baseline imaging. Blood cultures grew Streptococcus pneumoniae, confirming pneumococcal sepsis. During intensive care unit admission, he developed gross hematuria, progressive thrombocytopenia, prolonged coagulation times, and evidence of disseminated intravascular coagulation. Acute neurological deterioration prompted urgent CT imaging, which revealed extensive intraventricular hemorrhage with early hydrocephalus. Despite aggressive supportive care, including hemodynamic stabilization, transfusions, renal replacement therapy, and tailored antibiotics, the patient developed refractory shock and multiorgan failure. After multidisciplinary discussion and family consultation, care was transitioned to comfort measures, and he subsequently died. This case illustrates the fulminant and often fatal nature of pneumococcal sepsis complicated by disseminated intravascular coagulation and intracranial hemorrhage, emphasizing the need for early recognition, close monitoring, and multidisciplinary management in high-risk patients.