Erysipelas‐Like Cellulitis with Pasteurella Multocida Bacteremia—a Rare Presentation

1Maimonides Medical Center, Brooklyn, NY

Meeting: Hospital Medicine 2011, May 10-13, Dallas, Texas.

Abstract number: 316

Case Presentation:

A 79‐year‐old man with a medical history of gout presented with fever of 103°F, chills, palpitations, left lower‐extremity pain, swelling, and redness. Patient denied any trauma to his limb. Physical exam was unremarkable except for tachycardia, edema, induration, and intense erythema of the left lower leg with a sharply demarcated raised border, and chronic tophaceous gout involving the first metatarsophalangeal joint of his left foot with an ulcer over the gouty tophi. On specific elicitation of animal exposure, it was revealed that patient had 3 pet dogs. Patient denied any bites or scratches, but stated that the ulcer on his toe was licked by his dog. Laboratory tests revealed leukocytosis, with white blood cell count of 31.2 × 103/mm3. Treatment with intravenous vancomycin was started. Blood cultures grew Pasteurella multocida. Vancomycin was stopped, and intravenous ampicillin/sulbactam was initiated, after which the patient defervesced, and there was gradual resolution of the redness, swelling, and pain. The leukocytosis resolved. The patient continued to receive ampicillin/ sulbactam for 5 days and was discharged in stable condition to continue taking ampicillin for 10 more days.

Discussion:

Pasteurella multocida is a nonmotile, nonsporogenic, aerobic to facultatively anaerobic gram‐negative coccobacillus. It is a commensal in the respiratory and gastrointestinal tract of many domestic and wild animals, especially cats and dogs. Infection with P. multocida usually occurs after an animal bite, scratch, or licking and can present as cellulitis but rarely with erysipelaslike cellulitis. It can exhibit a rapidly progressive soft‐tissue inflammation that may resemble group A β‐hemolytic Streptococcus pyogenes infections. It manifests within several hours to 3 days, with fever, swelling, redness, and pain at the site with purulent, malodorous discharge. P. multocida can cause infection of skin, soft tissue, bone, joint, and the respiratory system. Bacteremia causing endocarditis and meningitis is rare. Erysipelas‐like cellulitis is even less frequently seen, with only 1 case reported in the literature, which occurred after a cat bite. Diagnosis is based on culture results. Bite infections are frequently polymicrobial, and amoxicillin/clavulanate is recommended to provide broad‐spectrum empirical coverage. We report a case of erysipelas‐like cellulitis with bacteremia due to Pasteurella multocida after a dog lick successfully treated with ampicillin/ sulbactam.

Conclusions:

Bacteremia caused by Pasteurella multocida is rare, with only 144 such cases reported in the medical literature from 1936 to 1999, mostly in an immunocompromised host. Erysipelas‐like cellulitis is even less frequently seen. We report a case of erysipelas‐like cellulitis with bacteremia due to Pasteurella multocida after a dog lick in an immunocom‐petent individual.

Disclosures:

K. Khurshid ‐ none; M. Pednekar ‐ none; K. C. Janga ‐ none; G. Todd ‐ none

To cite this abstract:

Khurshid K, Pednekar M, Janga K, Todd G. Erysipelas‐Like Cellulitis with Pasteurella Multocida Bacteremia—a Rare Presentation. Abstract published at Hospital Medicine 2011, May 10-13, Dallas, Texas. Abstract 316. Journal of Hospital Medicine. 2011; 6 (suppl 2). https://www.shmabstracts.com/abstract/erysipelaslike-cellulitis-with-pasteurella-multocida-bacteremiaa-rare-presentation/. Accessed May 22, 2019.

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