Tehran University of Medical Sciences Archives of Anesthesiology and Critical Care 2423-5849 0 0 2026 07 11 1556 1556 Fatemeh Afra Department of Clinical Pharmacy, School of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran. & Department of Anesthesiology and Critical Care, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran. Mojtaba Mojtahedzadeh Department of Clinical Pharmacy, School of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran. & Division of Critical Care Medicine, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran. & Anesthesia, Critical Care, and Pain Management Research Center, Tehran University of Medical Sciences, Tehran, Iran. Leila Sadat Hosseini Department of Anesthesiology and Critical Care, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran. Khashayar Shahverdi Department of Anesthesiology and Critical Care, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran. Maryam Albaji Department of Pulmonary Disease, School of Medicine, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran. Atabak Najafi Department of Anesthesiology and Critical Care, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran. Seyed Hamidreza Sharifnia Department of Anesthesiology and Critical Care, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran. & Anesthesia, Critical Care, and Pain Management Research Center, Tehran University of Medical Sciences, Tehran, Iran. Parisa Kianpour Anesthesia, Critical Care, and Pain Management Research Center, Tehran University of Medical Sciences, Tehran, Iran. Amirmohammad Shabani Anesthesia, Critical Care, and Pain Management Research Center, Tehran University of Medical Sciences, Tehran, Iran. & Department of Clinical Pharmacy, School of Pharmacy, Mazandaran University of Medical Sciences, Sari, Iran. Amirmahdi Mojtahedzadeh Center for Undergraduate Students Study in Medicine, Faculty of Medicine, Semmelweis University, Budapest, Hungary. 2026 01 17 2026 02 09 Organ-organ interactions play a crucial role in the progression and severity of critical illnesses such as sepsis. Dysregulated interaction among the heart, lungs, and kidneys (mediated by inflammatory, neurohormonal, and metabolic processes) can exacerbate organ dysfunction, contributing to the development of multi-organ failure. We report the case of a 70-year-old woman with significant comorbidities, including type 2 diabetes mellitus (DM-II), chronic kidney disease (CKD), heart failure (HF), nephrolithiasis, and morbid obesity, who was admitted with severe urosepsis caused by extended-spectrum β-lactamase (ESBL)-producing Escherichia coli. Her clinical course was further complicated by acute viral interstitial pneumonia progressing to ARDS. During the ICU admission, the patient experienced a complicated clinical course characterized by mixed septic and cardiogenic shock, right ventricular dysfunction, hypoxemic respiratory failure, and acute-on-chronic kidney injury. Treatment included lung-protective mechanical ventilation, hemodynamic support with inodilator therapy, insulin-dextrose-potassium administration, adjunctive therapies targeting inflammation and endothelial dysfunction, and judicious fluid management. Over the course of hospitalization, cardiac, respiratory, and renal function progressively improved, allowing discharge in a stable condition. This case highlights the clinically important role of organ-organ cross-talk in the development of multi-organ dysfunction during severe sepsis complicated by viral pneumonia. Hemodynamic instability, inflammation-related capillary leakage, and increased pressure within encapsulated organs may interact to perpetuate a cycle of organ injury, particularly in patients with underlying conditions such as heart failure, CKD, or obesity. Patient-specific management strategies may support organ recovery and improve clinical outcomes by disrupting this cycle. https://aacc.tums.ac.ir/index.php/aacc/article/view/1556