Sepsis is a common presentation to the emergency department (ED) with the main aim of treatment being prompt antibiotics, source identification and control, all preferably within the initial golden hour. In the majority of patients, a good history and examination is adequate to elicit the most likely source of infection and thus target therapy appropriately. However it is well known that this can be difficult in some patient groups. In this report we present two patients with sepsis with spinal cord injury (SCI) where both the history and examination were unhelpful in identifying the source of infection and demonstrate why the unique physiology and risk factors in SCI patients must be considered early in their work up. Both patients were admitted with vague, nonspecific constitutional symptoms. Both had no evidence of abdominal or flank pain or any objective tenderness. One of the patients had a long-term suprapubic catheter and one intermittently self catheterised meaning that urine dip stick results were unreliable. In both instances, the patients were found to have obstructed renal stones with associated infection and both had good outcomes after surgical intervention.
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