ABSTRACT
Liver transplant recipients are immunocompromised by the virtue of being on immunosuppressive agents which put them at risk of having infections from unusual and even multiple concomitant pathogens. We present a case of a 39-year-old man who developed septicaemia with Enterococcus casseliflavus, Streptococcus equinus and Klebsiella oxytoca in the setting of perinephric haematoma which resulted following a kidney biopsy performed to evaluate his nephrotic range proteinuria. E. casseliflavus has been known to cause infections in patients with liver disease/cirrhosis; however, simultaneous infection with S. equinus and K. oxytoca along with E. casseliflavus has never been reported earlier in post-transplant state.
Subject(s)
Hematoma/etiology , Kidney Diseases/complications , Klebsiella oxytoca/isolation & purification , Liver Transplantation/adverse effects , Sepsis/microbiology , Adult , Allografts/pathology , Anti-Bacterial Agents/administration & dosage , Anti-Bacterial Agents/therapeutic use , Biopsy/adverse effects , Drainage/methods , Enterococcus/isolation & purification , Hematoma/surgery , Humans , Immunocompromised Host , Immunosuppressive Agents/adverse effects , Infusions, Intravenous , Kidney/diagnostic imaging , Kidney/microbiology , Kidney/pathology , Kidney Diseases/diagnostic imaging , Kidney Diseases/microbiology , Kidney Diseases/pathology , Liver Cirrhosis/complications , Male , Proteinuria/diagnosis , Sepsis/complications , Sepsis/drug therapy , Streptococcus/isolation & purification , Streptococcus bovis , Treatment OutcomeABSTRACT
Serotonin syndrome is a clinical diagnosis characterized by a constellation of autonomic and neurological physical examination findings due to the use of one or more serotonergic agents. Due to high morbidity and mortality associated with this condition, high index of suspicion is required in making this diagnosis. Treatment is aimed at discontinuation of the offending agent and supportive care. We present a case of a 28-year-old woman who presented with acetaminophen toxicity, however developed iatrogenic serotonin syndrome due to use of scheduled intravenous metoclopramide. Metoclopramide, by itself, very rarely causes serotonin syndrome and typically results in this condition when used in combination with other pro-serotonergic agents.