Takeaway
- Case report highlights a rare death due to Capnocytophaga canimorsus acquired by a lick from a pet canine a few weeks prior to infection.
Why this matters
- Ask about contact with dogs/cats; consider C canimorsus in patients presenting with the aforementioned symptoms even in the absence of animal bites or scratches and in the presence of purpura, immunodeficiency.
- Pending definitive diagnosis, initiate empiric penicillin in combination with a beta-lactam inhibitor.
Key points
- 63-year-old man with fever, progressive dyspnea, facial petechiae, right lower limb dysesthesia, lower extremity myalgia.
- Patient reported being touched/licked by pet dog in previous weeks.
- Examination: lower limb ecchymoses, no open wounds, dyspnea at rest, respiration 36/minutes, hypoxic, anuric.
- Labs: thrombocytopenia, lymphocytopenia, elevated procalcitonin, C reactive protein (CRP), acute kidney injury, liver dysfunction, rhabdomyolysis, lactic acidosis.
- Suspected diagnosis: severe sepsis with purpura fulminans, antimicrobials initiated.
- Day 4: blood culture showed C canimorsus; day 8: CRP rising, Candida albicans cultured.
- Patient developed progressive epidermolysis of entire body, persistent infection followed by day 11 increase in CRP, procalcitonin, fever.
- CT scan: atypical centrilobular, peribronchovascular consolidation; Aspergillus fumigatus isolated in tracheal secretion.
- Abdominal CT scan showed splenic infarction, cranial CT showed signs of severe hypoxic edema. Patient died after 16 days of treatment.
References
References
