The Brief Case: Capnocytophaga sputigena Bacteremia in a 94-Year-Old Male with Type 2 Diabetes Mellitus, Pancytopenia, and Bronchopneumonia

Abstract

A 94-year-old male presented to the emergency department with 3 days of fever and total body weakness. The patient’s past medical history was significant for coronary artery disease, type 2 diabetes mellitus, gastroesophageal reflux disease, Parkinsonism, hypertension, and chronic kidney disease. Physical examination revealed fever (38.7°C), mild elevation in blood pressure (138/62 mm Hg) and a normal room air oxygen saturation of 96%. Lung sounds were distant, and no rales, wheezing, or rhonchi were appreciated. The patient presented with tachycardia (heart rate, 112 beats per minute [bpm]) without murmur, rub, or gallop. The patient’s abdomen was soft and nontender, and no peripheral edema was observed. Neurologic examination showed diffuse, generalized motor weakness and fine resting hand tremor but was otherwise normal. Recent laboratory tests showed pancytopenia (white blood cells, 1.16 × 103/mm3; platelets, 8 × 103/mm3) and low hemoglobin (8.5 g/dl). Creatinine was 1.78 mg/dl with a known baseline of 1.7 mg/dl. Chest X-ray (CXR) revealed peribronchial cuffing. The patient denied cough, diarrhea, mouth pain, nausea, or vomiting. No recent pet exposures or animal bites were reported. No mucositis, gingival disease, or mouth tenderness was noted in patient history. However, given the patient’s advanced age, tooth loss, and poor dental care, the existence of damage to the oral mucosa could not be ruled out. The patient’s social history was significant for residing at an assisted living facility where a coronavirus disease 2019 (COVID-19) outbreak had been present. The patient was initially suspected of having COVID-19, but initial and follow-up COVID-19 molecular testing were both negative. Two sets of blood cultures were obtained, and intravenous fluids were administered. Due to the peribronchial cuffing noted on CXR, ceftriaxone and azithromycin were initiated to treat for possible early bronchopneumonia. Within 24 h of admission, the patient developed acute hypotension and subsequently died of circulatory collapse.

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