Sepsis induced bacterial peritonitis caused by Granulicatella adiacens

• Published in: The American journal of emergency medicine 2019-12, Vol.37 (12), p.2263.e1-2263.e3
• Main Authors: Elfessi, Zane, Liu, Erica, Dukarevich, Yelena, Caniff, Kaylee, Marquez, Katrina, Shabbir, Zaheera
• Format: Article
• Language: English
• Subjects: Abdomen; Adult; Anti-Bacterial Agents - therapeutic use; Antibiotics; Ascites; Ascitic fluid; Bacterial peritonitis; Blood pressure; Carnobacteriaceae - isolation & purification; Catheters; Colon cancer; Dehydrogenase; Dehydrogenases; Emergency medical care; Emergency medical services; Endocarditis; Glucose; Gram-Positive Bacterial Infections - drug therapy; Gram-Positive Bacterial Infections - etiology; Gram-Positive Bacterial Infections - microbiology; Granulicatella adiacens; Heart rate; Humans; Infections; L-Lactate dehydrogenase; Lactic acid; Leukocytes (polymorphonuclear); Male; Metastases; Patients; Peritoneal fluid; Peritoneum; Peritonitis; Peritonitis - drug therapy; Peritonitis - etiology; Peritonitis - microbiology; Respiration; Respiratory rate; Sepsis; Sepsis - complications; Staphylococcus aureus - isolation & purification; Ultrasonic imaging; Vancomycin - therapeutic use
• ISSN: 0735-6757; 1532-8171
• DOI: 10.1016/j.ajem.2019.158428

To our knowledge, this is the first case describing clinically defined sepsis caused by secondary bacterial peritonitis in a patient with malignant ascites in which G. adiacens was isolated from ascitic fluid.2 Case A 38-year-old, 101 kilogram male with a past medical history of colon cancer status-post palliative open sigmoid resection with metastases to the liver and peritoneum complicated by recurrent symptomatic malignant ascites requiring a chronic indwelling PleurX™ (Becton, Dickinson and Company, Franklin Lakes, NJ) ascites drain, presented to the emergency department (ED) with worsening abdominal pain for three days, decreased fluid output from drain, and new onset severe shortness of breath for the last 2 h. In the ED, the patient was afebrile and other initial vitals including blood pressure, heart rate and respiratory rate were 92/62 mm Hg, 105 beats per minute, and 35 breaths per minute, respectively. Peritoneal fluid analysis revealed a nucleated cell count of 9163 with 83% polymorphonuclear leukocytes (PMNs), a total protein of 1.7 g/dL, glucose concentration less than 1 mg/dL and a lactate dehydrogenase (LDH) level of 1429 U/mL. Authors detail that the ascitic fluid in secondary peritonitis will likely reveal at least 2 of 3 specific lab abnormalities: a total protein content greater than 1 g/dL, a glucose concentration less than 50 mg/dL, and a lactate dehydrogenase (LDH) level greater 225 U/mL.