Advocate Lutheran General Hospital Park Ridge, IL, United States
Thomas A. Wichelmann, DO1, Ahmed Khattab, MD, MRCP1, Assad Munis, DO1, Ryan T. Hoff, DO2, Samir Kakodkar, MD1 1Advocate Lutheran General Hospital, Park Ridge, IL; 2Advocate Lutheran General hospital, Park Ridge, IL
Introduction: Pseudomonas aeruginosa is an opportunistic bacterium that commonly causes pneumonia and urinary tract infections. While cases of P. aeruginosa colitis have been infrequently reported, we identify a unique case of P. aeruginosa bacteremia occurring after antibiotic-treated P. aeruginosa colitis in a patient with alcohol-induced cirrhosis.
Case Description/Methods: A 38-year-old male with class III obesity and alcohol use disorder presented with cramping abdominal pain, vomiting and dark stool. There was no recent hospitalization and no antibiotic or intravenous drug use. Last alcoholic drink was reported to be several days prior to presentation. Physical exam identified scleral icterus, abdominal distension without tenderness, and hepatomegaly. Laboratory test results are outlined in Table 1. Serum acetaminophen and alcohol levels were not detected. Urinalysis and chest x-ray were unremarkable. Ultrasound demonstrated cirrhotic liver morphology and ascites, but no cholelithiasis. Ceftriaxone was started due to concerns for an upper gastrointestinal bleed. On day 2, he developed watery diarrhea. Stool cultures were positive for P. aeruginosa, prompting antibiotic transition to cefepime. Clostridioides difficile testing was negative. He completed a five-day course of cefepime with resolution of diarrhea and leukocytosis. Subsequently, he was started on methylprednisolone for treatment of alcoholic hepatitis, and later discharged on a tapering dose. Eleven days later, he returned with vomiting and generalized weakness, and was admitted to the intensive care unit with pansusceptible P. aeruginosa bacteremia and septic shock. Unfortunately, clinical condition continued to deteriorate despite maximal medical therapy, and he ultimately expired.
Discussion: P. aeruginosa has rarely been described in association with colitis. To our knowledge, this is the first reported case of P. aeruginosa colitis in a patient with alcohol-induced cirrhosis, and the first case of P. aeruginosa bacteremia after previously treated colitis. While the optimal duration of treatment for P. aeruginosa colitis is not well defined, this case supports extended antibiotic courses for the treatment of P. aeruginosa infections in decompensated cirrhosis and cautious post-treatment steroid utilization.
Laboratory Test
Value (First Admission)
Value (Second Admission)
Units
Normal Limits
White Blood Cell count
18.7
38.9
k/µL
4.2 - 11.0
Platelet count
183
66
k/µL
140 - 450
Lactic Acid, Venous
2.9
9.4
mmol/L
0.0 - 2.0
Sodium
133
133
mmol/L
135 - 145
Potassium
3.5
5.5
mmol/L
3.4 - 5.1
Bicarbonate
23
20
mmol/L
21 - 32
Blood urea nitrogen
107
121
mg/dL
6 - 20
Creatinine
7.17
9.70
mg/dL
0.67 - 1.17
Blood glucose
99
76
mg/dL
65 - 99
Total Bilirubin
27.3
25.2
mg/dL
0.1 - 1.0
AST
260
180
units/L
< 37
ALT
174
211
units/L
< 64
Alkaline Phosphatase
182
136
units/L
45 - 117
Albumin
2.0
1.8
g/dL
3.6 - 5.1
Prothrombin Time
24.9
25.2
seconds
9.7 - 11.8
Ammonia
95
80
µmol/L
< 33
Calculated MELD-Na
42
44
Maddrey's Discriminant Function (DF)
86.6
110.4
7-day Lille Model Score
0.267
Table: This table depicts initial admission laboratory testing results for the patient’s two separate admissions.
Disclosures: Thomas Wichelmann indicated no relevant financial relationships. Ahmed Khattab indicated no relevant financial relationships. Assad Munis indicated no relevant financial relationships. Ryan Hoff indicated no relevant financial relationships. Samir Kakodkar indicated no relevant financial relationships.
Thomas A. Wichelmann, DO1, Ahmed Khattab, MD, MRCP1, Assad Munis, DO1, Ryan T. Hoff, DO2, Samir Kakodkar, MD1. P1921 - A Rare Case of Pseudomonas Aeruginosa Colitis and Subsequent Bacteremia in the Setting of Alcohol-Induced Cirrhosis, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.
