Abstract Introduction Capnocytophaga is a species of slow-growing, gram-negative bacilli that can cause rare but serious infections in humans, more commonly in immunocompromised patients. The most common etiology is from animal bites, particularly from dogs. This case involves an immunocompetent patient who quickly decompensated after presenting with multiple acute symptoms stemming from Capnocytophaga bacteremia. Case A 75-year-old female patient was admitted for lactic acidosis with lactic acid of 7.2 mmol/L, thrombocytopenia with platelet count of 24 K/uL, diffuse joint pain, and diffuse nonblanchable rash. Over that night, the patient decompensated requiring vasopressors and mechanical ventilation, and the rash worsened with continued spread. Disseminated intravascular coagulation (DIC) was diagnosed from labs, and she was transfused blood products with resolution of DIC. The rash was determined to be purpura fulminans, and a broad differential was created for the etiology. Broad spectrum antibiotics were initiated, and Infectious Disease was consulted. While a thorough history was obtained by the patient during admission, other history was obtained from family, and it was found that patient had a dog bite one week prior to symptoms. A thorough and exhaustive list of labs, cultures, and markers were ordered which all resulted as negative, except for blood cultures returning positive for gram-negative rods on day 5. These cultures were then held for an extended period for further speciation. During the admission, the patient continued to be anuric and required continuous renal replacement therapy (CRRT). After one week, the patient was able to awaken, follow commands, and be extubated. With continued concerns of limb ischemia and skin necrosis from extensive purpura fulminans reducing quality of life, Palliative Care alongside ICU team had a family discussion which led to the patient discharging home on hospice. A day after discharge, the extended-hold blood cultures returned as Capnocytophaga species. Discussion This case was particularly interesting as Capnocytophaga bacteremia leads to severe symptoms and a fairly high mortality rate (∼30%) commonly seen in immunocompromised patients, but this patient was immunocompetent with an unremarkable medical history aside from age. Additionally, the quick decompensation was a surprising occurrence as the patient was completely alert, talkative, and hemodynamically stable when first evaluated. Throughout that night, the patient quickly became less responsive and more confused with evidence of shock even on antibiotics, fluids, and blood products. Capnocytophaga bacteremia can lead to such abrupt worsening in patient condition and coincides with the high mortality rate of patients. This abstract is funded by: None
Patel et al. (Fri,) studied this question.
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