Patient: Male, 78-year-old
Final Diagnosis: Bacteremia due to
Shewanella
species • empyema due to
Shewanella
species
Symptoms: Dyspnea • high fever
Clinical Procedure: —
Specialty: Infectious Diseases
Objective:
Unusual clinical course
Background:
Shewanella
spp. are gram-negative facultative anaerobic, oxidase-positive, motile bacilli that are ubiquitous but commonly occur in seawater and can cause opportunistic infection. Reports on the risk factors for
Shewanella
infection, its severity, antibiotic susceptibility, and prognosis are limited. This report is of a 78-year-old man with alcoholic cirrhosis presenting with bacteremia and empyema due to infection with
Shewanella
spp.
Case Report:
A 78-year-old man with alcoholic cirrhosis (Child-Pugh B) presented to our emergency room with a high fever. He had eaten raw fish one week prior to admission. Chest computed tomography showed a right unilateral pleural effusion, and he was hospitalized with suspected empyema.
Shewanella
spp. was detected in the pleural effusion and blood cultures. We initiated piperacillin/tazobactam and vancomycin empirically and switched to ceftriaxone; the effusion was successfully treated using antibiotics and pleural drainage. However, on hospitalization day 53, the patient died of aspiration pneumonia. In our literature review, we extracted 125 reported cases (including our case) and found that men were disproportionately affected (81%); median age was 61.6 (56-75) years; underlying diseases included hepatobiliary disease (33%), malignancy (25%), and cardiac disease (24%);
Shewanella
spp. infection sites were skin and soft tissue (35%), respiratory system (18%), and hepatobiliary system (11%); and management included antibiotics (100%), drainage (16%), and debridement (16%). The survival rate was 74% with antibiotics alone.
Conclusions:
Our case highlights that clinicians should recognize
Shewanella
spp. as a cause of empyema and bacteremia in patients with liver cirrhosis, and that microbiological diagnosis with antibiotic sensitivity testing and treatment should be undertaken urgently to prevent fatal sepsis.