SHM Converge Scientific Abstract ePoster Gallery-Seeing Through Initial Confusion: E. Avium Bacteremia.

Pdf Summary

This case highlights a diagnostic pitfall involving <strong>Enterococcus avium bacteremia</strong> and an <strong>incidental olfactory groove meningioma</strong>.

A <strong>71-year-old woman</strong> presented to an outside hospital with <strong>fever (102°F), altered mental status, tachycardia, and leukocytosis</strong>. She was started on <strong>ceftriaxone and vancomycin</strong>, and a head CT revealed an olfactory groove meningioma, prompting transfer for neurosurgical evaluation. On arrival, she was afebrile but remained disoriented, without focal neurologic deficits. Neurosurgery found no urgent indication for intervention. The key diagnosis came from the <strong>original blood cultures</strong>, which grew <strong>E. avium</strong>. She was then treated with <strong>intravenous ampicillin</strong>, with improvement and resolution of leukocytosis; repeat blood cultures were negative.

The report emphasizes that <strong>E. avium is rare</strong>, responsible for about <strong>1% of enterococcal infections</strong>, but can cause <strong>bacteremia</strong>, and less commonly endocarditis, urinary tract infections, osteomyelitis, or CNS infection. It is generally <strong>susceptible to ampicillin and vancomycin</strong>, and severe infections may require prolonged IV therapy.

The meningioma was an important but misleading incidental finding. Although meningiomas can cause headaches, seizures, visual symptoms, and cognitive changes, they <strong>do not explain fever or leukocytosis</strong> and usually do not present with acute altered mental status unless complicated by hemorrhage or infarction, which was not seen.

The main lesson is to avoid <strong>anchoring bias</strong> and <strong>confirmation bias</strong>. Clinicians should perform a <strong>diagnostic time-out</strong> when the clinical picture does not fit the most visible finding. In this case, the CNS mass could easily have distracted from the true cause of illness, but the blood culture result ultimately clarified the diagnosis.

Asset Subtitle

Cole Bourgeois

Meta Tag

Author List Bruno Álvarez Concejo, Cole Bourgeois, Julia H. Sawyer, Yazan Hijazein

Category Clinical Vignettes

Concept Enterococcus avium

Concept Bacteremia

Concept Antibiotic Therapy

Concept Intravenous Antibiotic Therapy

Concept Antibiotic susceptibility

Distinguished Non-Finalist

Presenter Organization LSU Health Shreveport

Presenting Author Cole Bourgeois

Track Adult

Keywords

Enterococcus avium

bacteremia

olfactory groove meningioma

altered mental status

fever

leukocytosis

blood cultures

ampicillin

anchoring bias

diagnostic pitfall

Enterococcus avium

Bacteremia

Antibiotic Therapy

Intravenous Antibiotic Therapy

Antibiotic susceptibility