Chest Infections |

Not Your Usual Suspect: A Case of Spontaneous Bacterial Peritonitis FREE TO VIEW

Kevin Patel, BS; Susan Mucha, MD; Raghukumar Thirumala, MD
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Allegheny General Hospital, Pittsburgh, PA

Chest. 2014;145(3_MeetingAbstracts):108A. doi:10.1378/chest.1836646
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SESSION TITLE: Infectious Disease Case Reports Posters II

SESSION TYPE: Case Report Poster

PRESENTED ON: Sunday, March 23, 2014 at 01:15 PM - 02:15 PM

INTRODUCTION: Spontaneous bacterial peritonitis (SBP) is commonly seen in patients with liver cirrhosis and carries a high mortality. We present a rare case of spontaneous bacterial peritonitis due to Listeria monocytogenes.

CASE PRESENTATION: Our patient is a 60 year old female with Sjögren syndrome, primary biliary cirrhosis, and end-stage liver disease awaiting liver transplant who presented to an outside facility with increasing lethargy and confusion. She was found to be in multiorgan failure with acute kidney injury, thrombocytopenia, coagulopathy, and shock with lactic acidosis. She was transferred to our institution and a diagnostic paracentesis revealed 12,800 WBC/mm3 with a differential of 87% neutrophils, 5% lymphocytes, and 8% monocytes. She was diagnosed with SBP and started on empiric ceftriaxone and administered intravenous 25% albumin. Her hospital course was complicated by hypoxemic respiratory failure and septic shock requiring mechanical ventilation and vasopressor support. She was started on continuous veno-venous hemodialysis. She had worsening anemia, thrombocytopenia, and coagulopathy requiring multiple blood product transfusions. On hospital day 6, ascitic and blood cultures grew Listeria monocytogenes and her antibiotics were changed to ampicillin. Her clinical condition improved and she was weaned off of vasopressors. However, her blood transfusion requirements increased and a repeat CT abdomen revealed a large retroperitoneal hematoma. Additionally, she developed recurrent sepsis requiring broad spectrum antibiotics and a bronchoscopy. Her course was further complicated by variceal bleed, severe hypoxemia, and multiorgan dysfunction syndrome. Respiratory cultures grew aspergillus fumigatus. On hospital day 24, the family pursued comfort measures and life support was withdrawn.

DISCUSSION: SBP is commonly caused by translocation of intestinal bacteria such as Escherichia coli, Klebsiella pneumoniae, Streptococcus species, and Enterobacteriaceae species. Listeria monocytogenes is a rare cause of SBP with 0.2 cases/100,000 annually in Europe and the US.

CONCLUSIONS: This case highlights the importance of considering Listeria monocytogenes as a potential pathogen in a patient who is not clinically responding to conventional cephalosporin therapy.

Reference #1: Cardoso C, Cremers I, Oliveira AP: Spontaneous bacterial peritonitis caused by Listeria monocytogenes: a case report and literature review. Ann Hepatol. 11 (6): 955-957, 2012.

Reference #2: Conn HO: Spontaneous peritonitis and bacteremia in Laennec’s cirrhosis caused by enteric organisms: A relatively common but rarely recognized syndrome. Ann Intern Med. 60 (4):568-580, 1964.

DISCLOSURE: The following authors have nothing to disclose: Kevin Patel, Susan Mucha, Raghukumar Thirumala

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