This week’s case highlighted a patient with fever and umbilical drainage who progressed into septic shock. The patient was started on ceftriaxone, vancomycin, and clindamycin for septic shock vs TSS. Started on NE in the ED for persistently widened pulse pressures. Transferred to the PICU, where she continued pressors until the next morning. Started on HFNC later that night for respiratory distress.

ID consulted, whose leading diagnosis was TSS in the setting of severe sepsis with rash and infection likely coming from umbilicus.  Dermatology disagreed with TSS diagnosis and favored diagnosis of drug reaction secondary to Bactrim as patient had normal WBC count and rash that was inconsistent with TSS rash. Did not believe this was a drug hypersensitivity syndrome as patient’s eosinophils were normal and she had no atypical lymphocytes. Surgery felt that sepsis picture was unlikely to come from umbilical site infection with CT only showing small fat-containing hernia.  Discharged on Doxycycline and Augmentin. Presented to the ED 5 days after discharge for feculent discharge from the umbilicus with bowel movements. US umbilicus negative. Underwent diagnostic laparoscopy and hernia repair on 4/9/25 with no patent urachus or omphalomesenteric duct remnant. The umbilical tract was sent to pathology for review.