Rare case of fatal Capnocytophaga canimorsus following dog lick

  • Mader N & al.
  • Eur J Case Rep Intern Med
  • 1 Jan 2019

  • International Clinical Digest
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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.

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