Precipitous hypotension in the emergency department caused by Capnocytophaga canimorsus sp nov sepsis.
A 20-year-old man presented to the emergency department (ED) with an injured right hand, fever, and a history of dog exposure. This splenectomized individual developed hypotension less than 90 minutes after arriving in the ED with normal vital signs. He later developed overwhelming sepsis, gangrene, disseminated intravascular coagulation (DIC), respiratory insufficiency, retroperitoneal hematoma, and renal insufficiency. Blood cultures grew Capnocytophaga canimorsus sp nov (formerly Dysgonic Fermenter-2). Sepsis, gangrene, and DIC are more likely to occur in asplenic individuals exposed to this organism. Many physicians use prophylactic outpatient penicillin therapy in asplenic or functionally asplenic victims of dog and cat bites. However, a brief admission or stay in an observation unit may be indicated for these high-risk individuals.
Howell
J M
JM
Department of Emergency Medicine, Joint Military Medical Command (JMMC), San Antonio, TX.
Woodward
G R
GR
D000328:Adult; D000818:Animals; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001424:Bacterial Infections / Q000150:complications* / Q000188:drug therapy; D002206:Capnocytophaga; D041964:Cytophagaceae; D004285:Dogs; D004630:Emergencies; D006801:Humans; D007022:Hypotension / Q000209:etiology*; D008297:Male; D012307:Risk Factors; D013156:Splenectomy
D000900:Anti-Bacterial Agents