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Occult sepsis in advanced dementia — SCE Acute Medicine MCQ

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HardMedicine in the ElderlyOccult sepsis in advanced dementiaSCE Acute Medicine

A 90-year-old woman with advanced dementia is brought in from a nursing home because she is less interactive and not eating. She is afebrile but respiratory rate is 30/min, systolic blood pressure is 92 mmHg and lactate is 4.1 mmol/L. Chest examination reveals new crackles at the right base. What is the most likely diagnosis?

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Correct answer: A — Sepsis presenting atypically with pneumonia

Older people with dementia may present with non-specific deterioration rather than fever, but tachypnoea, hypotension, raised lactate and focal chest signs indicate sepsis from pneumonia. Labelling this as dementia progression risks missing reversible acute illness. Dehydration may coexist but does not explain focal respiratory findings. The pearl is that absence of fever does not exclude severe infection in frailty.

Reference: https://www.nice.org.uk/guidance/ng253#acute-medicine-order-76-1