A Case of Persistent Pasteurella multocida Cellulitis Complicated With Large Endocarditis Vegetation
Abstract
In the realm of infective endocarditis, a distinct and infrequent player emerges - Pasteurella multocida, an organism more commonly associated with zoonotic infections, now warranting careful consideration in this unique case report. P . multocida is a Gram-negative, facultative anaerobic cocco-bacillus and a common member of the oral bacterial flora of cats and dogs. In humans, it commonly causes skin and wound infections after bites and scratches. Disseminated P . multocida infection seeded into the heart valve is very rare and has only been reported in about one case per year worldwide with only 42 cases found in the literature and only five cases reported to have underlying liver cirrhosis as in our case. This is a case of a 73-year-old female with a past medical history of Child-Pugh B liver cirrhosis secondary to primary biliary cholangitis with portal hypertension, splenomegaly, pancytopenia, severe aortic stenosis, and paroxysmal atrial fibrillation presented to hospital with generalized weakness, fever, and new lower extremity rash 48 hours after last dose of antibiotic. She had recent hospitalization for left lower extremity cellulitis and P. multocida bacteremia and received 14 days of high-dose oral amoxicillin-clavulanate with negative blood culture prior to discharge. She occasionally helps her son to feed his cats and dog whenever he travels. She was readmitted and a repeat blood culture showed P. multocida. Transthoracic echocardiogram showed a 1.9 cm × 1 cm…
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