Pasteurella multocida meningitis with disseminated intravascular coagulation and multi-organ failure in an adult with no bite history
A 70-year-old woman with an extensive past medical history presented to the emergency
center with two weeks of generalized weakness, fatigue, resting shortness of breath, and
abdominal pain. The patient was bradycardic and hypotensive and was admitted to the
intensive care unit. Within a few hours of admission, she developed worsening lethargy and
respiratory acidosis and required intubation and vasopressor support. Laboratory results were
remarkable for azotemia, anemia, and thrombocytopenia. Magnetic resonance imaging of the
brain was unremarkable; an EEG reported mildly generalized slowing and no epileptiform
waves. Cerebrospinal fluid culture was positive for Pasteurella multocida. The patient later
developed acute hepatic injury, acute kidney injury, and an elevated D-Dimer with a decreased
fibrinogen consistent with disseminated intravascular coagulation. After twelve days her family
decided for comfort care only; the patient was extubated and died.
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