[Lethal Salmonella enteritidis meningoencephalitis in an adult with a carcinoma of an unknown primary site].
A 71-year-old man with an aortobifemoral bypass graft had experienced several episodes of severe pain in the thoracic and lumbar spine, followed by severe abdominal pain, during the preceding two weeks. Physical examination, chest X-ray, ultrasonography and computed tomography of the abdomen provided no specific pointers to a diagnosis. He was anaemic (haemoglobin 95 g/l), but had a normal WBC count with neutrophilia (up to 91%) and thrombocytopenia (up to 24,000/microliters). The transaminase and lactate dehydrogenase activities were raised, as were the bilirubin level and the retention values. There was a metabolic acidosis (pH 7.20). Because of suspected septicaemia ciprofloxacin (twice daily 200 mg) was administered intravenously. But the patient gradually lost consciousness, required mechanical ventilation and died 24 hours after admission in circulatory failure. Autopsy revealed a meningoencephalitis, carcinoma of unknown primary with bone marrow carcinomatosis as well as widespread carcinomatosis of blood and lymph vessels. The findings of blood, urine and sputum cultures, available only postmortally, revealed growth of tetracycline-resistant Salmonellae enteritidis.
Weber
J
J
Zentrum für Innere Medizin, Robert-Bosch-Krankenhauses Stuttgart.
Mettang
T
T
Fritz
P
P
D000368:Aged; D001853:Bone Marrow / Q000473:pathology; D001921:Brain / Q000473:pathology; D002277:Carcinoma / Q000150:complications / Q000473:pathology*; D006801:Humans; D008297:Male; D008590:Meningoencephalitis / Q000209:etiology / Q000473:pathology*; D009382:Neoplasms, Unknown Primary / Q000150:complications / Q000473:pathology*; D012480:Salmonella Infections / Q000209:etiology / Q000473:pathology*; D012477:Salmonella enteritidis