Chavez Herrera Victor Ramzes, Rosas De Silva Maria Fernanda, Orendain Alcaraz Homero, Ceja Espiritu Gabriel, Carrazco Peña Karla, Melnikov Valery
Instituto Mexicano de Seguro Social, General Hospital Zona #1, University of Colima, Faculty of Medicine, Colima, Mexico.
Instituto Mexicano de Seguro Social, General Hospital Zona #1 , Colima, Mexico.
J Med Case Rep. 2018 Nov 3;12(1):328. doi: 10.1186/s13256-018-1866-x.
Cedecea lapagei bacterium was discovered in 1977 but was not known to be pathogenic to humans until 2006. In the medical literature there are very few clinical case reports of Cedecea lapagei; none have reported a catastrophic death secondary to a soft tissue hemorrhagic bullae infection. As well as soft tissue infection, rare cases of pneumonia, urinary tract infections, peritonitis, osteomyelitis, bacteremia, and sepsis have been documented with the majority having good outcomes. Here, we present the first case of a fatal outcome in a Cedecea lapagei soft tissue infection with multiple hemorrhagic bullae.
A 52-year-old Mexican man with antecedents of liver cirrhosis and treated hypertension was brought to our institution with clinical signs of sepsis and 16 to 18 hours of history of pain and edema in his right lower limb. During the course of the first day hospitalized in our institution, he developed several large serohematogenous bullae with ascending progression on his entire right lower limb. He subsequently developed multiple organ failure and septic shock with rapid deterioration, dying on the second day. Bullae fluid samples taken the first day undoubtedly isolated Cedecea lapagei within the second day using MicroScan WalkAway® 96 plus System as well Gram-negative bacteria in MacConkey and blood agar.
The isolation of Cedecea lapagei was an unexpected etiological finding that will enable physicians in the future to consider this bacterium as a probable cause of serohematogenous bullae infections. We do not exclude contamination although it has never been isolated in bullae fluid in the medical literature. Future encounters with this bacterium should not be taken lightly as it may have the potential to have fatal outcomes.
拉氏西地西菌于1977年被发现，但直到2006年才被认为对人类具有致病性。在医学文献中，拉氏西地西菌的临床病例报告非常少；尚无报告称因软组织出血性大疱感染继发灾难性死亡。除软组织感染外，罕见的肺炎、尿路感染、腹膜炎、骨髓炎、菌血症和脓毒症病例也有记录，大多数患者预后良好。在此，我们报告首例拉氏西地西菌软组织感染伴多发出血性大疱导致死亡的病例。
一名52岁的墨西哥男子，有肝硬化病史且高血压已接受治疗，因出现脓毒症临床症状以及右下肢疼痛和水肿16至18小时被送至我院。在我院住院的第一天，他整个右下肢出现了几个大的血清血性大疱，并呈进行性上升。随后他出现多器官功能衰竭和感染性休克，病情迅速恶化，于第二天死亡。第一天采集的大疱液样本在第二天无疑通过MicroScan WalkAway® 96 plus系统以及在麦康凯和血琼脂上培养出革兰氏阴性菌，从而分离出拉氏西地西菌。
拉氏西地西菌的分离是一个意外的病因学发现，这将使医生在未来能够将这种细菌视为血清血性大疱感染的可能病因。尽管在医学文献中从未在大疱液中分离出该菌，但我们不排除污染的可能性。今后遇到这种细菌时不应掉以轻心，因为它可能会导致致命后果。
