2001 Associates' Presentations

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Pseudomonas Escapes the Hospital

S. Jacob
A. Otters
University of Wisconsin, Milwaukee Medical Campus, Sinai Samaritan Medical Center, Milwaukee, Wisconsin

Case: A 78 year-old Caucasian lady with a history of diabetes mellitus type 2 and hypertension presented with a history of nausea, feeling unwell, and diaphoresis for about 1 week. Her medications included antihypertensives and oral hypoglycemics. The examination revealed a lethargic and diaphoretic woman who was febrile and tachycardic associated with a systolic murmer.

Laboratory evaluation showed an elevated WBC count of 15,800 with 82% polys and 10% bands, moderate hyperglycemia and elevated troponin I. Her EKG and CXR were unremarkable. A transthoracic echo showed mitral and aortic stenosis. Blood cultures were drawn for three consecutive days, all of which grew quinolone sensitive Pseudomonas aeruginosa. On the third day of admission, while on antibiotics, the patient developed flash pulmonary edema. A transesophageal echocardiogram showed a moderately large flail vegetation on the mitral valve with accompanying mitral insufficiency. She had mitral and aortic valve replacement surgery, but two weeks later died likely due to complications from embolisation of the vegetation to the brain. There was no identifiable source of infection on comprehensive endoscopic and radiological investigations.

Discussion: Pseudomonas is a fairly common cause of sepsis and infective endocarditis in nosocomial settings, with other sources of sepsis, and in people with vascular access devices. Here we present a case of community acquired Pseudomonas aegugenosa endocarditis. A review of literature to date showed no other cases of left sided endocarditis by Pseudomonas aerogenosa without an identifiable source of sepsis.

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