Fulminant septic shock due to Edwardsiella tarda infection associated with multiple liver abscesses: a case report and r
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(2020) 14:144
CASE REPORT
Open Access
Fulminant septic shock due to Edwardsiella tarda infection associated with multiple liver abscesses: a case report and review of the literature Gultakin Hasan Bakirova1*, Abdulrahman Alharthy1, Silvia Corcione2, Waleed Tharwat Aletreby1, Ahmed Fouad Mady1,3, Francesco Giuseppe De Rosa2 and Dimitrios Karakitsos1,4
Abstract Introduction: Edwardsiella tarda uncommonly infects humans. The usual presentation is mild gastroenteritis, but systemic manifestations may occur. Lethal infections are rarely documented in patients with underlying disorders. Case presentation: A previously healthy 37-year-old Southeast Asian woman presented to our hospital with recent onset of abdominal pain, fever, and vomiting. Her condition rapidly deteriorated with signs and symptoms of fulminant septic shock; thus, she was intubated, supported with intravenous vasopressors and fluids, and transferred to the intensive care unit. An abdominal computed tomographic scan with contrast revealed multiple liver abscesses. Blood cultures were obtained and computed tomography–guided percutaneous drainage of the liver abscesses with supplementary cultures was performed; thereafter, empirical broad-spectrum antibiotics were initiated. All cultures grew E. tarda, whereas an antibiogram showed resistance to broad-spectrum antibiotics and sensitivity to ciprofloxacin and aminoglycosides; thus, the antibiotic regimen was updated accordingly. The patient made an uneventful recovery and was discharged from the intensive care unit 14 days after admission. Conclusion: E. tarda human infection can present as liver abscess and fulminant septic shock. E. tarda strains can be resistant to broad-spectrum antibiotics; hence, culture-based antibiotics should be used accordingly. Clinicians should be aware of this rare and potentially lethal infection. Keywords: Case report, Edwardsiella tarda, Septic shock, Liver abscess
Introduction Edwardsiella tarda is a gram-negative, facultative anaerobe that is a member of the family Enterobacteriaceae and was first described by Ewing et al. in 1965 [1]. Since then, a growing body of literature has reported E. tarda isolates particularly related to brackish water and marine ecosystems, including reptiles, amphibians, and fish [2]. E. tarda human infections are rare and mainly present * Correspondence: [email protected] 1 Critical Care Department, King Saud Medical City, Riyadh, Saudi Arabia Full list of author information is available at the end of the article
as gastroenteritis; however, extraintestinal and systemic infections have been reported that, when present, are a potentially life-threatening condition carrying up to 50% risk of mortality [3]. Such infections include bacteremia; infections of skin, soft tissue, and biliary tract; liver and tubo-ovarian abscesses; and peritonitis, particularly in immunocompromised hosts [4, 5]. We report a case of E. tarda infection that presented as multiple liver abscesses leading to fulminant septic shock in a previously healthy 37-year-ol
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