Pasteurella multocida meningitis with disseminated intravascular coagulation and multi-organ failure in an adult with no bite history

Abstract

A 70-year-old woman with an extensive past medical history presented to the emergency center with two weeks of generalized weakness, fatigue, resting shortness of breath, and abdominal pain. The patient was bradycardic and hypotensive and was admitted to the intensive care unit. Within a few hours of admission, she developed worsening lethargy and respiratory acidosis and required intubation and vasopressor support. Laboratory results were remarkable for azotemia, anemia, and thrombocytopenia. Magnetic resonance imaging of the brain was unremarkable; an EEG reported mildly generalized slowing and no epileptiform waves. Cerebrospinal fluid culture was positive for Pasteurella multocida. The patient later developed acute hepatic injury, acute kidney injury, and an elevated D-Dimer with a decreased fibrinogen consistent with disseminated intravascular coagulation. After twelve days her family decided for comfort care only; the patient was extubated and died.

Keywords

• meningitis, Pasteurella multocida, multi-organ failure, disseminated intravascular coagulation