Icahn School of Medicine at Mount Sinai (Elmhurst Hospital Center) Elmhurst, NY, United States
Asad Ahmed, BS1, Jonathan Reyes, MD2, Salman Syed, MD2, Tasur Seen, MD2, Sowmya Kalava, MD2 1St. George's University School of Medicine, Elmhurst, NY; 2Icahn School of Medicine at Mount Sinai (Elmhurst Hospital Center), Elmhurst, NY
Introduction: Gut-derived complications in liver cirrhosis are common and often result in pathological bacterial translocation. This phenomenon is well described in the literature, especially as the mechanism of severe complications in cirrhotic patients. This is a case of an obscure bacteria in a cirrhotic patient. While most of these translocations are due to overgrowth of normal gut flora or proliferation of common gastrointestinal culprits such as E. coli, Pantoea agglomerans infections are very rare.
Case Description/Methods: This is a 36 y/o M with PMHx of ETOH abuse and psoriasis who presented to the ED with painful abdominal distension, bilateral lower extremity edema, and diarrhea. He was admitted for decompensated cirrhosis requiring a series of large-volume paracentesis. On admission day 9 shortly after a suspected traumatic paracentesis the patient was found to be septic with a fever to 103.7 F, tachycardia to 137 bpm, and hypotension to 88/42. Cultures were drawn prior to initiation of empiric antibiotics Vancomycin and Ceftriaxone. Blood cultures drawn before the initiation of broad-spectrum antibiotics grew ampicillin-resistant Pantoea agglomerans.
Discussion: Pantoea agglomerans is a gram-negative bacteria of the Erwiniaceae family found predominantly in plants as well as the general environment. Multiple strains of Pantoea have been isolated in plant and animal products, human feces, and the soil. Due to its role in plant products, it has been implicated in multiple respiratory infections especially byssinosis as well as wound infection, abscesses, bacteremia, pneumonia, urinary tract infection, septic arthritis, osteomyelitis, peritonitis, and choledocholithiasis. Although there has been a significant increase in reported cases of infectious Pantaeo Aggleromans especially in immunocompromised patients, few have described and discussed intra-abdominal infections or infections in cirrhotic patients. Additionally, none of the reported cases were associated with an iatrogenic microperforation event. This case is to inform clinicians of a rare microbe that is commonly overlooked, review the pathogenesis of bacterial translocation in cirrhotics, and review the risks of paracentesis.
Asad Ahmed indicated no relevant financial relationships.
Jonathan Reyes indicated no relevant financial relationships.
Salman Syed indicated no relevant financial relationships.
Tasur Seen indicated no relevant financial relationships.
Sowmya Kalava indicated no relevant financial relationships.
Asad Ahmed, BS1, Jonathan Reyes, MD2, Salman Syed, MD2, Tasur Seen, MD2, Sowmya Kalava, MD2. P0824 - Pantoea Agglomerans Bacteremia in a Cirrhotic Patient, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.