RESUMO
Pasteurella multocida (P. multocida) is a gram-negative coccobacillus that comprises the normal oral, upper respiratory, and gastrointestinal flora of many wild and domestic animals. Disease transmission primarily occurs via animal bites, scratches, and licks on broken skin. P. multocida most commonly causes skin and soft tissue infection and local abscess formation; however, we report a unique case of spinal epidural abscess due to P. multocida infection in a patient with a history of recent epidural steroid injection and repeated cat bites. There is little documentation of P. multocida infection causing spinal epidural abscesses in any patient population, particularly in immunocompetent hosts. This case demonstrates that P. multocida may cause a spinal epidural abscess in a healthy individual without manifesting any other signs or symptoms of the disease process. Thus, it is important to elicit a detailed history regarding animal contact and associated injury. Unless overt sepsis or clinical stability necessitate blood cultures with corresponding administration of broad-spectrum antimicrobials, targeted IV antimicrobial therapy should be initiated after collection and culture of the epidural abscess aspirate.
RESUMO
INTRODUCTION: Calcium channel blockers (CCBs) are commonly used but have the potential to cause substantial toxicity. One such underreported toxicity of CCB use is the development of acute respiratory distress syndrome (ARDS). CASE PRESENTATION: 44-year-old previously healthy woman presented to the emergency department (ED) having taken 60 tablets of 125 mg extended-release verapamil and 90 tablets of 0.25 mg clonazepam with the intent to commit suicide. On presentation to the ED, she was sedated and intubated for airway protection. She received aggressive medical resuscitation and was ventilated using low tidal volume mechanical ventilation. The hospital course was complicated by worsening hypoxia and a chest x-ray demonstrating bilateral patchy geographic areas of airspace opacities consistent with ARDS. On day 5 of hospitalization, the patient's clinical status improved significantly, and she was subsequently weaned off vasopressors and extubated. DISCUSSION: CCB toxicity can result in profound hypotension, shock, bradycardia, and conduction blocks, as well as hyperglycemia, acidosis and acute kidney injury, and ARDS. It is important for clinicians to understand the signs and symptoms of CCB toxicity, as well as how to treat it.
