Multisystem Management in a Geriatric Patient with Intracerebral Hemorrhage, Acute Kidney Injury, Stenotrophomonas Maltophilia Pneumonia, and Paraphimosis: A Clinical Case Report

Introduction: Intracerebral hemorrhage (ICH) is a highly lethal neurological emergency in elderly patients, especially when associated with systemic complications such as acute kidney injury (AKI) and nosocomial infections caused by multidrug-resistant microorganisms. This report describes the clinical course and multidisciplinary management of an elderly patient with ICH who developed AKI superimposed on chronic kidney disease (CKD), pneumonia caused by Stenotrophomonas maltophilia, and paraphimosis.

Case Report: An elderly male patient with a history of arterial hypertension, type 2 diabetes mellitus, and visual impairment was admitted to the intensive care unit with decreased level of consciousness and sudden-onset aphasia. Computed tomography revealed ICH associated with ischemic stroke. During hospitalization, he developed AKI secondary to urinary obstruction due to paraphimosis, requiring emergency dialysis. S. maltophilia was isolated from tracheal aspirate, and targeted antibiotic therapy was initiated. Integrated management included ventilatory support, nephrological care, rational antibiotic use, and urological intervention. The patient showed clinical improvement, restoration of urine output, and was discharged with a structured home care plan.

Conclusion: Early, individualized, and interdisciplinary management was essential for the recovery of a geriatric patient with multiple simultaneous critical conditions. Identification of reversible causes, such as obstructive paraphimosis, and adequate control of hospital-acquired infection were crucial to achieving a favorable outcome.