COMPLICATED PLEURAL EFFUSION CAUSED BY PASTEURELLA MULTOCIDA IN A PATIENT WITH RHABDOMYOLOYSIS: A CASE REPORT

Abstract

SESSION TITLE: Medical Student/Resident Pulmonary Manifestations of Systemic Disease Posters SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: October 18-21, 2020 INTRODUCTION: Pasteurella multocida is present in the oral, nasopharyngeal and upper respiratory tract of cats, dogs, and other animals. This organism most commonly causes skin and soft tissue infections following animal bites and scratches; however, cases of respiratory illness have been reported. Here, we present an interesting case of P. multocida bacteremia and complicated pleural effusion discovered in a patient with rhabdomyolysis. CASE PRESENTATION: A 73-year-old female immunocompetent patient suffered a fall, spent two days on the ground, and was brought to the emergency department by EMS. There she was found to have rhabdomyolysis as well as bacteremia which grew Pasteurella multocida. Computed Tomography (CT) scans demonstrated loculated effusions in the bilateral lower lobes, initially more severe on the right side. The patient required a right-sided thoracentesis and left sided chest tube with administration of tPA-dornase and recovered with initiation of antimicrobial therapy. DISCUSSION: Pasteurella multocida is a gram-negative bacterium transmitted to humans by animal bite, though reports of transference through saliva alone have been reported. Our patient remembered being bitten by her cat when she initially fell, but a history of exposure cannot always be elicited. Indeed, many elderly patients cannot recall the events surrounding a fall but those exposed to secretions of pets through inhalation or bites can develop P. Multocida complications. In most immunocompetent persons, this bacteria causes cellulitis or localized wound infections. Our patient subsequently developed a complicated effusion. Pasteurella multocida infection of the respiratory tract is an unusual, but a known sequela of bacteremia among case reports. The development of pleural effusion secondary to P. multocida mostly occurred in the setting of chronic respiratory disease or immunocompromised state. We were unable to identify any reports of P.multocida pleural effusions occurring concurrently with or sequentially to rhabdomyolysis, as was seen in this patient. Rhabdomyolysis can develop after bacterial infections including legionella(1) and mycoplasma pneumonia(2), as well as after viral infections including influenza. However, rhabdomyolysis has not been directly linked as an inciting factor in the development of respiratory illness in humans. In rats, it was found that rhabdomyolysis induced ultrastructural impairment of the lung with Type II cell damage. This suggests that rhabdomyolysis can induce tissue injury associated with increased oxidative stress which can progress to acute lung injury.(3) CONCLUSIONS: In conclusion, we presented a case of complicated pleural effusion secondary to P. multocida infection in a patient with rhabdomyolysis. Obtaining patient history of animal contact is an important addition to fall questionnaires, as it may encourage the use of empiric treatment to cover for P.multocida. Reference #1: Sutarjono B, Alexis J, Sachidanandam JC. Legionella pneumonia complicated by rhabdomyolysis. BMJ Case Reports. 2019;12(6):10-12. doi:10.1136/bcr-2019-229243 Reference #2: Byrd RP, Roy TM. Rhabdomyolysis and bacterial pneumonia. Respiratory Medicine. 1998;92(2):359-362. doi:10.1016/S0954-6111(98)90123-8 Reference #3: Rodrigo R, Trujillo S, Bosco C. Biochemical and ultrastructural lung damage induced by rhabdomyolysis in the rat. Experimental Biology and Medicine. 2006;231(8):1430-1438. doi:10.1177/153537020623100817 DISCLOSURES: No relevant relationships by Katherine Polednik, source=Web Response No relevant relationships by Tejas Sangoi, source=Web Response No relevant relationships by Keniesha Thompson, source=Web Response