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A 62-year-old man presented to the emergency department with a 5-day history of severe abdominal pain with low-grade fever. Medical history included diabetes mellitus and hypertension. He had tachycardia, hypotension, and diffuse abdominal tenderness. Investigations showed white blood cell counts of 22,400/mm 3 (4000-10,000/mm 3 ), blood urea of 180 mg/dl (9-43 mg/dl), creatinine of 1.8 mg/dl (0.66-1.25 mg/dl), and procalcitonin of 180 ng/ml (,0.5 ng/ml). Urinalysis showed plenty of white blooddoi:10.34067/kid.0002402020 fatcat:uydyd47375e7rlesz2hd5rsyvi