A case of urosepsis with atypical presentation

Background A 39 year old woman with a history of ovarian cysts and pyelonephritis presented to our emergency department with the chief complaint of right sided flank pain of 22 hours duration. The pain had been slowly increasing and was severe at presentation. The pain was constant, centered in the right upper quadrant with radiation to the epigastrium, back and lower right quadrant. She had vomited three times prior to presentation. There was no urinary frequency or dysuria and normal bowel movements. No vaginal bleeding or discharge.