SHM Converge Scientific Abstract ePoster Gallery-Capnocytophaga Canimorsus Causing Septic and Cardiogenic Shock in an Immunocompromised Patient

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This case report describes a fatal infection caused by <em>Capnocytophaga canimorsus</em> in a 54-year-old woman with heavy alcohol use and likely alcohol-associated cirrhosis, making her immunocompromised. She presented to the emergency department with nausea, dizziness, weakness, and vomiting after a recent dog bite/scratch to her hand that initially appeared minor.

On arrival, she was critically ill: febrile, profoundly hypotensive, and severely hypoxic, requiring immediate intubation. Physical exam showed diffuse mottling and abdominal ecchymosis, with only a small scratch on the right hand and no obvious local infection. Laboratory studies revealed lactic and metabolic acidosis, high procalcitonin, pancytopenia, elevated troponin, hyponatremia, hypoglycemia, hypomagnesemia, and transaminitis. Echocardiography showed severely depressed left ventricular function with an ejection fraction of 24%, indicating cardiogenic shock in addition to septic shock.

Despite aggressive management with broad-spectrum antibiotics, inotropes, vasopressors, fluids, blood product transfusions, stress-dose steroids, and continuous renal replacement therapy, her condition worsened. Blood cultures took more than 48 hours to identify the unusual organism, later confirmed as <em>Capnocytophaga canimorsus</em>. She developed multiorgan failure and disseminated intravascular coagulation, with worsening purpura and new intra-abdominal fluid on repeat imaging. After continued decline, the family chose comfort care, and she died after compassionate extubation.

The discussion emphasizes that <em>C. canimorsus</em> is a gram-negative organism that can cause life-threatening infection after dog or cat bites, scratches, or saliva exposure, especially in patients with asplenia, hyposplenism, excessive alcohol use, or cirrhosis. Early recognition and prompt treatment with supportive care and empiric antibiotics such as a carbapenem or beta-lactam/beta-lactamase inhibitor are crucial.

Asset Subtitle

Sara Hassan

Meta Tag

Author List Natalie Millet, Sara Hassan

Category Clinical Vignettes

Concept Capnocytophaga canimorsus

Concept Sepsis

Concept Dog Bite

Concept Immunocompromised State

Concept Asplenia

Distinguished Non-Finalist

Presenter Organization Ocean University Medical Center

Presenting Author Sara Hassan

Track Adult

Keywords

Capnocytophaga canimorsus

dog bite infection

septic shock

cardiogenic shock

cirrhosis

alcohol use disorder

multiorgan failure

disseminated intravascular coagulation

gram-negative bacteremia

empiric antibiotics

Capnocytophaga canimorsus

Sepsis

Dog Bite

Immunocompromised State

Asplenia