Look What the Cat Dragged in: Bacteremic Pasteurellosis in a Cirrhotic Patient

1Atlanta Medical Center, Atlanta, GA
2Atlanta Medical Center, Atlanta, GA
3Atlanta Medical Center, Atlanta, GA

Meeting: Hospital Medicine 2009, May 14-17, Chicago, Ill.

Abstract number: 187

Case Presentation:

This is a case of a 62‐year‐old white man with a history of cirrhosis secondary to hepatitis C, currently on treatment. His chief complaint was sore throat for 1 week, now with SOB for 1 day. Review of systems was positive for abdominal pain. On initial exam the patient was hyperventilating, tachycardic, and wheezing. The patient deteriorated and developed respiratory failure and was intubated in the ED. Chest X‐ray was compatible with pulmonary edema, and EKG showed sinus tachycardia. Significant laboratory abnormalities included pH 7.05, HCO3 7 mEq/L, WBC 8.4 K/mm3 with 42% bands, platelets 68/μL, and creatinine 1.7 mg/dL. On detailed physical exam after intubation, the abdomen was distended with active bowel sounds and dull flanks, but what caught our attention were multiple skin lesions—catlike scratches noted on his upper extremities, some of them crusted, others with signs of swelling. There was no lymphadenopathy or purulent discharge. The patient's partner confirmed the existence of a house cat. He was started on empiric antibiotics with ceftriaxone and piperacillin/tazobactam. His condition worsened, and despite maximum support, he went into cardiac arrest with unsuccessful resuscitation. Follow‐up of his blood cultures revealed Pasteurella multocida in 4 of 4 bottles.

Discussion:

Pasteurella multocida is a gram‐negative coccobacilli known to be a cause of zoonotic infections in humans. Infections can present localized in soft tissues, in bony areas (tenosynovitis, septic arthritis), as respiratory tract infections (pharyngitis, lung abscess), or systemically with stow or fulminant development, including meningitis and septic shock. Life‐threatening systemic infection is uncommon (fewer than 50 cases reported in the literature) and is limited to patients at the extremes of age or those who are immunocompromised. Treatment of choice is beta‐lactam antibiotics, but even with appropriate therapy, bacteremic pasteurellosis carries an overall mortality rate of 30%–60%. Because of the seemingly benign nature of the scratches, our patient was late asking for medical help, and his presentation was late stage: He had the soft‐tissue infection, respiratory component, and even though not diagnosed, possible peritoneal infection, all leading to the fatal outcome with septic shock.

Conclusions:

We encourage primary health care providers to explain the risk of animal exposure to patients at risk. Pasteurella is the first organism to consider in any patient with impaired host defenses who presents with an animal injury. In view of the high mortality, antibiotic treatment should be instituted as soon as possible with a beta‐lactam agent.

Author Disclosure:

M. Carrington, none.

To cite this abstract:

Pimentel‐Brugal E, Carrington M, Lim T. Look What the Cat Dragged in: Bacteremic Pasteurellosis in a Cirrhotic Patient. Abstract published at Hospital Medicine 2009, May 14-17, Chicago, Ill. Abstract 187. Journal of Hospital Medicine. 2009; 4 (suppl 1). https://www.shmabstracts.com/abstract/look-what-the-cat-dragged-in-bacteremic-pasteurellosis-in-a-cirrhotic-patient/. Accessed July 16, 2019.

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