Background Lactobacillus species are Gram-positive commensal organisms found in the human body. Although generally considered low-virulence organisms and most often dismissed as contaminants, Lactobacillus species isolated from blood cultures have increasingly been recognized as causes of invasive infections in patients with severe comorbidities. Pyogenic liver abscess associated with Lactobacillus is exceedingly rare. Case presentation A 51-year-old woman with poorly controlled diabetes mellitus presented with fever, abdominal pain, acute encephalopathy, and generalized weakness. She was found to have severe diabetic ketoacidosis. Abdominal imaging revealed a large multiloculated liver abscess that was drained. Gram stain of the aspirate fluid revealed gram-positive rods, and two blood culture sets obtained 4 h apart grew Lactobacillus fermentum. The patient was treated with appropriate antimicrobial therapy for 6 weeks in addition to source control with percutaneous drainage, resulting in marked clinical improvement. Conclusion This case adds to the small body of literature describing Lactobacillus-associated pyogenic liver abscess. Isolation of Lactobacillus species from sterile sites should prompt careful clinical review rather than automatic dismissal as contamination.
Cases of drug-resistant Shigella are being reported across the United States. While traditionally linked to contaminated food and water, there is a rise in sexual transmission, especially among high-risk populations. We present a case of extensively drug-resistant Shigella flexneri and Chlamydia trachomatis co-infection in a person living with HIV.
Capnocytophaga species are fastidious gram-negative bacilli found in the oral flora of dogs and cats. Although human infection is typically associated with localized soft tissue disease following animal exposure, invasive infection can result in severe sepsis. We present a case of Capnocytophaga bacteremia in an immunocompetent woman with occupational exposure to dogs. A 49-year-old woman with a history of Factor V Leiden mutation, prior deep vein thrombosis and pulmonary embolism, and Raynaud’s syndrome presented with fever, chills, fatigue, myalgias, abdominal pain, vomiting, diarrhea, and transient vaginal bleeding. Evaluation revealed acute kidney injury, lactic acidosis, transaminitis, severe thrombocytopenia, and a petechial rash. An extensive infectious and autoimmune workup was unrevealing. Further history revealed recurrent occupational exposure to dogs as a photographer and walker, including a recent healing scratch to her right arm without evidence of local infection. Due to persistent leukocytosis and lack of clinical improvement, antimicrobial therapy was escalated to meropenem, resulting in gradual clinical and laboratory recovery. Blood cultures eventually grew Capnocytophaga species after delayed growth on anaerobic media. The patient was transitioned to oral amoxicillin-clavulanate to complete a two-week course. Susceptibility testing could not be performed because of insufficient organism growth. This case highlights the potential for severe Capnocytophaga bacteremia in an immunocompetent host with recurrent occupational exposure to animals. The nonspecific presentation and difficulty identifying this fastidious organism contributed to diagnostic uncertainty and delayed targeted therapy. Clinicians should consider Capnocytophaga infection in patients with unexplained sepsis and a history of animal exposure, even in the absence of a significant bite wound or overt soft-tissue infection.
