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The Brief Case: Capnocytophaga sputigena Bacteremia in a 94-Year-Old Male with Type 2 Diabetes Mellitus, Pancytopenia, and Bronchopneumonia

CASE A94-year-old male presented to the emergency department with 3 days of fever and total body weakness. The patient’s past medical history was significant for coronary artery disease, type 2 diabetes mellitus, gastroesophageal reflux disease, Parkinsonism, hypertension, and chronic kidney disease. Physical examination revealed fever (38.7°C), mild elevation in blood pressure (138/62mm Hg) and a normal room air oxygen saturation of 96%. Lung sounds were distant, and no rales, wheezing, or rhonchi were appreciated. The patient presented with tachycardia (heart rate, 112 beats per minute [bpm]) without murmur, rub, or gallop. The patient’s abdomen was soft and nontender, and no peripheral edema was observed. Neurologic examination showed diffuse, generalized motor weakness and fine resting hand tremor but was otherwise normal. Recent laboratory tests showed pancytopenia (white blood cells, 1.16 103/ mm3; platelets, 8 103/mm3) and low hemoglobin (8.5 g/dl). Creatinine was 1.78mg/dl with a known baseline of 1.7mg/dl. Chest X-ray (CXR) revealed peribronchial cuffing. The patient denied cough, diarrhea, mouth pain, nausea, or vomiting. No recent pet exposures or animal bites were reported. No mucositis, gingival disease, or mouth tenderness was noted in patient history. However, given the patient’s advanced age, tooth loss, and poor dental care, the existence of damage to the oral mucosa could not be ruled out. The patient’s social history was significant for residing at an assisted living facility where a coronavirus disease 2019 (COVID-19) outbreak had been present. The patient was initially suspected of having COVID-19, but initial and follow-up COVID-19 molecular testing were both negative. Two sets of blood cultures were obtained, and intravenous fluids were administered. Due to the peribronchial cuffing noted on CXR, ceftriaxone and azithromycin were initiated to treat for possible early bronchopneumonia. Within 24 h of admission, the patient developed acute hypotension and subsequently died of circulatory collapse. Two sets of anaerobic blood culture bottles (Bactec; Becton, Dickinson, Sparks, MD) collected at the time of admission signaled positive on day 4 of incubation. Thin, spindle-shaped, Gram-negative bacilli were observed on Gram stain (Fig. 1A and B). After 24 h, very small, gray, nonhemolytic colonies with spreading edges grew on a Columbia blood agar plate incubated at 35°C with 5% CO2 (Fig. 1C). They reached 2 to 4mm in diameter after 2 to 4 days and were convex or flat and slightly yellow. The colonies were resistant to vancomycin (5mg; Hardy Diagnostics, Santa Maria, CA) and penicillin (10 IU; Becton, Dickinson, Sparks, MD) disks (Fig. 1C), and there was no growth on MacConkey plates. The isolate was identified as Capnocytophaga sputigena by matrixCitation Liu BM, Carlisle CP, Fisher MA, Shakir SM. 2021. The Brief Case: Capnocytophaga sputigena bacteremia in a 94-year-old male with type 2 diabetes mellitus, pancytopenia, and bronchopneumonia. J Clin Microbiol 59: e02472-20. https://doi.org/10.1128/JCM.02472 -20. Editor Carey-Ann D. Burnham, Washington University School of Medicine Copyright © 2021 American Society for Microbiology. All Rights Reserved. Address correspondence to Salika M. Shakir, salika.shakir@aruplab.com. For answers to the self-assessment questions and take-home points, see https://doi.org/10 .1128/JCM.02473-20 in this issue. Published 18 June 2021