SESSION TYPE: Critical Care Case Report Posters
PRESENTED ON: Tuesday, October 23, 2012 at 01:30 PM - 02:30 PM
INTRODUCTION: Pasteurella multocida (P multocida) most commonly affects immunosuppressed hosts and is not typically associated with bacteremia. Most cases of bacteremia occur from wound infections secondary to a cat- or dog-bite. We present a 33-year old woman with a history of systemic lupus erythematosis (SLE) with nephritis who presented with rapid onset multiple organ dysfunction syndrome (MODS) and bacteremia due to P multocida, an uncommon pathogen in severe sepsis. To our knowledge, this is the first case report of P. multocida to cause bacteremia in a patient with SLE who had not sustained a wound infection.
CASE PRESENTATION: A 33-year old female with a history of lupus nephritis on no immunosuppressive medications presented to the emergency department with dyspnea and malaise for several days. She was afebrile but tachypneic and hypoxic despite 100% FiO2 oxygen supplementation. Her respiratory status rapidly declined, requiring mechanical ventilation. The chest radiograph revealed multiple lobulated areas of consolidation and multilobar opacities. She had a WBC of 1.0 K/uL, 14% bands, and a lactic acid of 6.2 mmol/L. A bronchoscopy demonstrated purulent secretions and serial BAL aliquots were negative for alveolar hemorrhage. She received vancomycin, piperacillin/tazobactam, azithromycin, methylprednisolone and heparin. She continued to decompensate clinically developing hypotension requiring aggressive volume resuscitation, norepinephrine, epinephrine, and vasopressin. Despite maximal hemodynamic and respiratory support including high frequency oscillatory ventilation, she sustained cardiopulmonary arrest and expired within hours of admission. Two blood cultures were rapidly positive for gram negative rods, later identified as P multocida, and the BAL culture subsequently P multocida. In discussion with her family after her passing, the patient had puppies that would affectionately lick the patient’s mouth, thus potentially exposing mucosal surfaces to infected secretions.
DISCUSSION: P multocida is a rare cause of bacteremia, and it is even rarer to isolate it from bronchial samples. This case is unique in that the patient had lupus nephritis, not a well described condition associated with this pathogen, and had not sustained a wound infection. Despite appropriate antibiotic coverage, the patient developed severe sepsis syndrome with MODS including acute kidney injury and ARDS.
CONCLUSIONS: In conclusion, we believe this to be the first case report of a patient with SLE without a wound infection to present with P. Multocida bacteremia leading to MODS.
1) Vondra, M.S.; Myers, J.P. "Pasteurella multocida bacteremia: Report of 12 cases in the 21st Century and comprehensive review of the adult literature." Infectious Diseases in Clinical Practice, 2011, 19, 3, 197-203
DISCLOSURE: The following authors have nothing to disclose: Anisha Arora, Hector Payan, Stephanie Levine
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