B48-33 A Silent Danger: Intensive Care Unit-Acquired Dysphagia in Sporadic Creutzfeldt-Jakob Disease Leading to Aspiration Pneumonia

Introduction Aspiration pneumonia is a major cause of morbidity among intensive care unit (ICU) patients, particularly those with neurologic deficits. Post-extubation dysphagia from ICU-acquired weakness and encephalopathy often persists and may be underrecognized during ICU-to-ward transitions. Superimposed neurodegeneration, such as sporadic Creutzfeldt-Jakob disease (sCJD), further heightens this risk. We report a case of aspiration pneumonia occurring shortly after percutaneous endoscopic gastrostomy (PEG) feeding in a patient with prolonged critical illness and probable sCJD. Case Presentation A 77-year-old man with atrial fibrillation, hypertension, and obstructive sleep apnea presented with four days of hematochezia after resuming apixaban following surveillance colonoscopy. Colonoscopy revealed multiple ulcerated masses; biopsy confirmed adenocarcinoma, and he underwent a partial colectomy with terminal ileum resection and ileocolostomy. The postoperative course was complicated by an anastomotic leak with septic shock requiring emergent surgical repair. He developed rapidly progressive encephalopathy and hypotension necessitating ICU admission, norepinephrine support, and hemodialysis. Blood cultures grew Enterococcus faecium; he received intravenous piperacillin-tazobactam and daptomycin. After 11 days in the ICU, vasopressors were discontinued, and he was hemodynamically stable for transfer to the medical ward. On the ward, encephalopathy and severe dysphagia persisted. He remained on a nothing by mouth diet, and neurology was consulted. Brain MRI showed asymmetric restricted diffusion in the caudate, putamen, and parietal cortex, highly suggestive of sCJD. Cerebrospinal fluid studies were nondiagnostic, and 14-3-3 protein testing was unavailable; however, based on clinical and imaging findings, he met diagnostic criteria for probable sCJD. Given sustained dysphagia, a PEG was placed for nutrition. Within 48 hours of starting PEG feeds, he developed fever, tachypnea, leukocytosis, and new chest-radiograph infiltrates consistent with aspiration pneumonia. Amid poor neurologic prognosis and progressive multiorgan failure, he was transitioned to hospice care and passed away. Discussion To our knowledge, aspiration pneumonia after PEG initiation in probable sCJD during ICU-to-ward transition is exceedingly rare and underreported. This case illustrates a compounded risk in which ICU-acquired dysphagia, weakness, and encephalopathy impair swallow coordination and airway reflexes, while sCJD accelerates neurologic decline. When airway reflexes are not restored, especially in profoundly encephalopathic patients, PEG feeding does not mitigate aspiration risk; any enteral feeding route can precipitate aspiration. Accordingly, meticulous multidisciplinary swallow reassessment before PEG placement and explicit ICU-to-ward handoffs emphasizing ongoing aspiration precautions are essential. We aim to raise awareness of this complex interplay and encourage proactive strategies to reduce aspiration-related complications in this vulnerable population. This abstract is funded by: None