A Difficult Microbiologic Diagnosis of Spontaneous Peritonitis

Abstract

The patient is a 72-year-old man with a medical history of cirrhosis secondary to alcohol use who was admitted because of decompensated cirrhosis and ascites.Five months before his current admission, the patient was hospitalized for decompensated cirrhosis and found to have spontaneous bacterial peritonitis (SBP) with peritoneal cultures growing Bacteroides fragilis. He was treated with metronidazole for a 7-day course.On presentation, he reported 7 days of gradually worsening abdominal pain and distension and lower extremity edema, without diarrhea. On admission, temperature was 96.2°F, heart rate 72 beats per minute, respiratory rate 18 breaths per minute, and blood pressure 107/67 mm Hg. Physical examination was notable for mild respiratory distress, scleral icterus, and bibasilar crackles. Abdomen was soft, distended with a palpable fluid wave, and had mild tenderness to palpation over his epigastric area. The lower extremities were edematous, and on skin examination, there were diffuse spider angiomata and telangiectasias.Laboratory evaluation demonstrated a white blood cell count of 7.0 K/μL, hemoglobin 9.2 g/dL, and platelets 40 K/μL (baseline, 130 K/μL). His liver function tests were only remarkable for a total From the