title: A rare case of Waterhouse-Friderichsen syndrome caused by Capnocytophaga canimorsus in an immunocompetent patient.
abstract: A 53-year-old Caucasian male with hypertension and active tobacco abuse presented to a community hospital with a 2-day history of vague abdominal pain, myalgia and increased lethargy after being bitten on his right hand by the family dog while camping just 3 days prior to symptom onset. He expired within 90 min upon arrival to our intensive care unit. Pre-mortem blood cultures grew a fastidious Gram-negative aerobic rod that was identified as Capnocytophaga canimorsus. Autopsy findings showed multi-organ disseminated intravascular coagulopathy with microthrombi along with bilateral adrenal hemorrhage and necrosis of the adrenal glands consistent with Waterhouse-Friderichsen syndrome. This case contributes to the medical literature as a rare presentation of Capnocytophaga canimorsus infection in an otherwise immunocompetent patient and stresses the importance of a thorough history taking and physical examination by clinicians along with prompt administration of appropriate antibiotics.
authors: Department of Internal Medicine, Geisinger Medical Center, 100 North Academy Avenue, Danville, PA, 17822, USA. jdcooper@geisinger.edu.
authors: Joseph David
authors: JD
authors: Cooper
authors: Department of Pathology, Geisinger Medical Center, 100 North Academy Avenue, Danville, PA, 17822, USA.
authors: Robert Patrick
authors: RP
authors: Dorion
authors: Department of Critical Care Medicine, Geisinger Medical Center, 100 North Academy Avenue, Danville, PA, 17822, USA.
authors: Joseph Lorenzo
authors: JL
authors: Smith
mesh_terms: D001344:Autopsy; D001733:Bites and Stings / Q000150:complications; D002206:Capnocytophaga / Q000302:isolation & purification*; D017809:Fatal Outcome; D016905:Gram-Negative Bacterial Infections / Q000150:complications* / Q000175:diagnosis*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012907:Smoking; D014884:Waterhouse-Friderichsen Syndrome / Q000209:etiology* / Q000473:pathology*
keywords: Capnocytophaga canimorsus; Dog bite; Waterhouse-Friderichsen syndrome