AN UNUSUAL BUG IN THE SPUTUM

Janak Adhikari, MD1, Priyadarshani Sharma, MD2, Jong Park, MD3, 1Steward Carney Hospital, MA; 2Reading Hospital- Tower Health, Wyomissing, PA; 3Steward Carney Hospital, Dorchester

Meeting: Hospital Medicine 2018; April 8-11; Orlando, Fla.

Abstract number: 428

Categories: Adult, Clinical Vignettes, Hospital Medicine 2018

Case Presentation: A 81 year Albanian male presented to the emergency with pain in right upper abdomen. Abnormal vitals during presentation were temperature of 101.8F, respiratory rate of 24/min and blood pressure of 85/66mmg Hg. Right upper quadrant was tender to touch with positive murphy’s sign. Lab work demonstrated WBC of 18.8 with band neutrophil of 20%. Abdominal ultrasonography demonstrated cholelithiasis and HIDA scan demonstrated complete obstruction of the gallbladder. The patient underwent laprascopic cholectystectomy. His postoperative course was complicated by persistent leukocytosis, new oxygen requirement and cough. On postop day 6, repeat abdominal CT showed a significant subhepatic fluid collection after which a CT-guided percutaneous drain was placed, that drained 10 cc of thick sanguinous fluid. Over the next 24 hours there was minimal fluid drainage. On postop day 9 the drain was removed. Given persistent cough, increased oxygen requirement, shortness of breath and persistent leukocytosis, chest X ray (CXR) and sputum culture was done. CXR showed small bibasilar atelectasis and sputum culture demonstrated comamonas testesteroni resistant to amikacin, tobramycin and gentamycin but sensitive to ceftriaxone, peperacillin-tazobactum, ampicillin-sulbactum and cotrimoxazole. He was started on ampicillin-sulbactum with resolution of his symptoms and leukocytosis within 48 hours.

Discussion: Comamonas testosterone occurs in soil, plants, water and also in hospital devices, such as intravenous lines and the humidifier reservoir water in respiratory equipments. It has been reported to cause infection such as cellulitis (1), peritonitis especially with a perforated appendix (2), bloodstream infection (3), infective endocarditis (4), purulent meningitis, (5) postoperative endophthalmitis (6) and hemodialysis catheter-related bacteremia (7).However to our knowledge, growth in respiratory tract is very uncommon.

Conclusions: We present a case of Comamonas testosterone isolated from a sputum sample after laproscopic cholecystectomy in a setting of cough, increased oxygen requirement and persistent leukocytosis.

To cite this abstract:

Adhikari, J; Sharma, P; Park, J. AN UNUSUAL BUG IN THE SPUTUM. Abstract published at Hospital Medicine 2018; April 8-11; Orlando, Fla. Abstract 428. https://www.shmabstracts.com/abstract/an-unusual-bug-in-the-sputum/. Accessed September 23, 2019.

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