Catecholamine-Induced Multiorgan Failure and Arterial Thrombosis: A Rare Manifestation of Pheochromocytoma in the Setting of Community-Acquired Pneumonia

Pheochromocytoma is a rare catecholamine-secreting tumor that has a highly variable presentation and may result in life-threatening complications. In the most severe cases, massive release of catecholamines can lead to refractory shock, acute cardiomyopathy, and multiorgan failure. The diverse clinical manifestations of pheochromocytoma often make diagnosis challenging in critical care settings. We report a 25-year-old woman who presented with acute abdominal pain, vomiting, pleuritic chest pain, and a productive cough and was initially managed as community-acquired pneumonia complicated by septic shock. She rapidly deteriorated, requiring intubation, vasopressor support, and advanced cardiac life support following cardiac arrest. Bedside echocardiography showed severe global left ventricular systolic dysfunction with an estimated ejection fraction of 20%-25%. During her stay in the intensive care unit, a femoral catheterization was performed for vascular access and hemodynamic monitoring. However, in the context of a catecholamine excess state, she subsequently developed acute ischemia of the left lower limb. Computed tomography angiography (CTA) showed extensive arterial occlusion, and an incidental 4 × 4 cm left adrenal mass was discovered. Follow-up biochemical testing showed markedly elevated plasma metanephrines and normetanephrines, supporting the diagnosis of pheochromocytoma. Despite treatment with thrombectomy, her limb ischemia was irreversible, necessitating an above-knee amputation. With supportive care and initiation of α-adrenergic and β-adrenergic blockade, her cardiac and renal function gradually improved. She was stabilized and referred for definitive surgical management. This case highlights that pheochromocytoma crisis may mimic septic shock and can present with severe cardiomyopathy and limb-threatening arterial thrombosis. Early consideration of catecholamine excess in unexplained refractory shock or multiorgan failure is important, since early diagnosis and targeted treatment can be lifesaving and help prevent irreversible complications.