Bilateral acute renal cortical necrosis after a dog bite: case report

Background Capnocytophaga canimorsus is a Gram-negative capnophilic rod and part of dogs/cats’ normal oral flora. It can be transmitted by bites, scratches, or even by contact of saliva with injured skin. Asplenic patients and patients with alcohol abuse are at particular risk for fulminant C. canimorsus sepsis. However, also immunocompetent patients can have a severe or even fatal infection. This is the first case of a severe C. canimorsus infection in an immunocompromised host complicated by acute renal cortical necrosis with a “reverse rim sign” in contrast-enhanced computed tomography on hospital admission. Case presentation We report the case of a 44-year functionally asplenic patient after an allogeneic stem cell transplantation, who presented with septic shock after a minor dog bite injury 4 days prior. Because of abdominal complaints, epigastric pain with local peritonism, and radiological gallbladder wall thickening, an abdominal focus was suspected after the initial work-up. The patient underwent emergent open cholecystectomy, but the clinical suspicion of abdominal infection was not confirmed. Septic shock was further complicated by cardiomyopathy and disseminated intravascular coagulation. As a causative pathogen, C. canimorsus could be isolated. The clinical course was complicated by permanent hemodialysis and extensive acral necrosis requiring amputation of several fingers and both thighs. Conclusion We present a severe case of a C. canimorsus infection in a functionally asplenic patient after a minor dog bite. The clinical course was complicated by septic shock, disseminated intravascular coagulation, and the need for multiple amputations. In addition, the rare form of acute renal failure - bilateral acute renal cortical necrosis – was visible as “reverse rim sign” on computed tomography scan. This case is an example of the potential disastrous consequences when omitting pre-emptive antibiotic therapy in wounds inflicted by cats and dogs, particularly in asplenic patients.

Case Report: Overwhelming Babesia Parasitemia Successfully Treated Promptly With RBC Apheresis and Triple Therapy With Clindamycin, Azithromycin, and Atovaquone

Babesiosis with high-grade parasitemia is life-threatening, especially in asplenic hosts. We report an asplenic patient with parasitemia >50% who was successfully treated with prompt red blood cell apheresis and triple therapy with clindamycin + azithromycin + atovaquone. This regimen may be an alternative to poorly tolerated clindamycin + quinine in severe cases.

Navigating the Management of an F-16 Pilot Following Spontaneous Splenic Rupture

BACKGROUND: Little consensus exists on the best practices for post-acute care of patients who suffer splenic injury but retain functional splenic tissue. Moreover, no published guidance or case reports exist for managing pilots in this demographic, making the flight surgeon’s task particularly difficulty as he/she attempts to apply the best available evidence for a patient population exposed to unique occupational hazards.CASE REPORT: We describe the case of an F-16 pilot who suffered a spontaneous splenic rupture due to infectious mononucleosis and required splenic artery embolization for hemodynamic stabilization. Despite the salvage of a significant portion of his spleen, the pilot was managed as an asplenic patient due to concern that: 1) splenic artery embolization compromised the function of his spleen; and 2) his status as a military aviator placed him at increased risk of infection due to frequent travel. He received appropriate vaccinations for an asplenic patient, fever precautions, and amoxicillin-clavulanic acid for immediate use if he developed fever. After discussion with the Aeromedical Consult Service, who felt the aviator had minimal risk of a poor outcome, he was returned to flying status. Since returning to flying status he has logged over 15 h of flight time, routinely experiencing 8–9 +Gz without difficulty.DISCUSSION: This case provides a successful approach to the management of pilots of high-performance aircraft who suffer splenic injury but retain functional splenic tissue, and provides precedent for safely returning these patients to flying status following recovery.Tanael M, Saul S. Navigating the management of an F-16 pilot following spontaneous splenic rupture. Aerosp Med Hum Perform. 2019; 90(12):1061–1063.