Plesiomonas shigelloides Septic Shock Leading to Death of Postsplenectomy Patient with Pyruvate Kinase Deficiency and Hemochromatosis.

Mohammed Samannodi,Yaser Nemshah,Andrew Zhao,Kevin Shiley

doi:10.1155/2016/1538501

Abstract

Although Plesiomonas shigelloides, a water-borne bacterium of the Enterobacteriaceae family, usually causes self-limiting gastroenteritis with diarrhea, several cases of sepsis have been reported. We report the case of a 43-year-old male patient with hemochromatosis, pyruvate kinase deficiency, and asplenia via splenectomy who developed septic shock caused by P. shigelloides complicated by respiratory failure, renal failure, liver failure, and disseminated intravascular coagulation. Early aggressive antimicrobial therapy and resuscitation measures were unsuccessful and the patient passed away. We kindly suggest clinicians to implement early diagnosis of septic shock, empirical coverage with antibiotics, and prompt volume resuscitation based on the high mortality rate of P. shigelloides bacteremia.

Highlights

Plesiomonas shigelloides is an oxidase-positive, anaerobic gram negative bacillus bacteria of the Enterobacteriaceae family which normally reside in soil and fresh water environments including the Great Lakes
A 43-year-old Caucasian gentleman with past medical history of homozygous hereditary hemochromatosis and pyruvate kinase deficiency leading to a splenectomy at 4 years of age was admitted to the Buffalo Mercy Hospital with a threehour history of fever, chills, and generalized weakness
The patient had three possible sources for P. shigelloides infection: the addition of a new puppy, recent consumption of clams, and illegal swimming in Lake Erie. He had a medical history of homozygous hereditary hemochromatosis and pyruvate kinase deficiency which led to a splenectomy during childhood

Summary

Introduction

Plesiomonas shigelloides is an oxidase-positive, anaerobic gram negative bacillus bacteria of the Enterobacteriaceae family which normally reside in soil and fresh water environments including the Great Lakes. P. shigelloides is distributed among warm- and cold-blooded animals like dogs and seafood. Plesiomonas shigelloides usually causes self-limited diarrheal illness but can lead to extraintestinal infections with immunocompromised patients and patients with underlying hepatobiliary disease like hemochromatosis [7,8,9,10,11,12,13]. Bacteremia caused by P. shigelloides is very rare with only 36 reported cases with our case being the 36th. The literature has shown a significant mortality associated with P. shigelloides sepsis in 16 cases with ours being the latest one [7, 8, 10, 11, 13,14,15,16]

Case Presentation

Discussion