Purr-ils of the Liver: A Case of Disseminated Pasteurella in a Patient With MASH Cirrhosis

Document Type

Conference Proceeding

Publication Date

10-2024

Publication Title

American Journal of Gastroenterology

Abstract

Introduction: Pasteurella Multocida is a gram-negative coccobacillus that is transmitted to humans by other mammals, often domesticated pets. Disseminated infection by P. multocida, including peritonitis, is typically associated with peritoneal dialysis. We present a case of disseminated P. multocida infection with bacteremia and peritonitis in a patient with metabolic associated steatohepatitis (MASH) cirrhosis. Case Description/Methods: A 62-year-old man with a medical history of MASH cirrhosis with sequela of portal hypertension presented to the emergency center for altered mental status. Vitals were significant for a temperature of 102.5 F, RR 24. On physical exam, the patient had petechiae on his bilateral lower extremities, distended abdomen, and asterixis. Labs were significant for creatinine 1.91 mg/dL, hemoglobin 10.2 g/dL, platelets 32 bil/L, and procalcitonin 14.39 ng/mL. Diagnostic paracentesis was performed, which yielded 30cc of cloudy, red-yellow fluid, which was cultured. The patient was empirically started on vancomycin and cefepime before being transitioned to ceftriaxone for suspected spontaneous bacterial peritonitis (SBP). Peritoneal cell count showed 10,965 nucleated cells and 98% neutrophils. Blood cultures and peritoneal fluid cultures later grew P. multocida. The patient was started on lactulose and rifaximin for his hepatic encephalopathy. Upon resolution of altered mentation, the patient reported that he had recently adopted a kitten and had suffered several scratches on his bilateral upper extremities one month prior to this presentation. He had sought evaluation at urgent care then and was treated with intramuscular ceftriaxone followed by a course of amoxicillin-clavulanate and was subsequently asymptomatic until this hospital presentation. The patient remained on ceftriaxone during his hospital stay and repeat blood and peritoneal cultures remained without growth until discharge. Discussion: In our review of the literature, P. multocida is rarely implicated as a cause of SBP in the absence of peritoneal dialysis, which was the case of our patient. Repeat cultures following therapy with IV ceftriaxone showed resolution of our patient’s infection and he was discharged home on indefinite prophylactic therapy with ciprofloxacin. This case highlights a rare occurrence of disseminated P. multocida in the absence of peritoneal dialysis despite sufficient initial antimicrobial therapy, emphasizing the immunologic frailty of this patient population (see Figure 1).

Volume

119

Issue

10S

First Page

S2918

Comments

American College of Gastroenterology Annual Scientific Meeting, October 25-30, 2024, Philadelphia, PA

Last Page

S2919

DOI

10.14309/01.ajg.0001047768.91740.a1

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