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Erysipelothrix rhusiopathiae peritonitis in a patient undergoing continuous ambulatory peritoneal dialysis.

Shin SJ, Gwak WG - J. Korean Med. Sci. (2010)

Bottom Line: He was suffered from mild abdominal pain with a distinctive erysipeloid skin lesion.E. rhusiopathiae was considered to be introduced through a lacerated wound on his hand when he was exposed to contaminated materials.He was treated successfully with a first generation cephalosporin.

View Article: PubMed Central - PubMed

Affiliation: Department of Internal Medicine, Dongguk University Ilsan Hospital, Goyang, Korea. shine@duih.org

ABSTRACT
Erysipelothrix rhusiopathiae is known as a pathogen of occupational diseases or a zoonosis. We report a case of E. rhusiopathiae peritonitis in a 50-yr-old male undergoing continuous ambulatory peritoneal dialysis (CAPD). He was suffered from mild abdominal pain with a distinctive erysipeloid skin lesion. E. rhusiopathiae was considered to be introduced through a lacerated wound on his hand when he was exposed to contaminated materials. He was treated successfully with a first generation cephalosporin. To our knowledge, CAPD peritonitis due to E. rhusiopathiae is very rare, and this is a report of the first case in Asia.

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III-demarcated erythematous, violaceous macules especially on the dorsum of right index finger.
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Figure 1: III-demarcated erythematous, violaceous macules especially on the dorsum of right index finger.

Mentions: Four days before he visited the hospital, he sustained a small lacerated wound on his right index finger while trimming the nail, but did not seek care. The next day, he had mild abdominal pain, loose stools, and several bullous skin lesions that progressed from the right hand and forearm to the back area. He claimed that the exchanged CAPD fluid was clear. He thought the symptoms might be due to food poisoning because he ate raw fish the day before the symptoms developed. When he sought evaluation at our hospital, the vital signs were stable and he was afebrile. The initial bullous skin lesions that he described had almost resolved and were replaced with erythematous, violaceous macular lesions (Fig. 1). There was a diffuse abdominal tenderness, but without signs of peritoneal irritation. The CAPD fluid was slightly turbid. Both first and third generation cephalosporins were administered intraperitoneally according to the hospital recommendation for CAPD peritonitis. The initial cell count of the peritosol showed a white blood cell (WBC) of 1,600/µL (polycytes, 70%; lymphocytes, 12%; and others, 18%) with no red blood cells. Gram positive rods were demonstrated on gram stain. At the next visit on day 3, the abdominal pain was markedly improved. As a causative pathogen, E. rhusiopathiae was identified by a GNI-plus card with a Vitec II compact system (BioMeriux, Marcy-I'Etoile, France). The colonies on the blood agar plate were small and transparent, showing negativity for catalase, oxidase, and methyl red. On slants of triple sugar iron (TSI) agar, hydrogen sulfide was detected as a black precipitate. E. rhusiopathiae showed antibiotic susceptibility to cephalosporins, penicillin, erythomycin, and clindamycin, but resistance to vancomycin. The repeat examination of the CAPD fluid showed a WBC count of 42/µL (polycytes, 4%; lymphocytes, 17%; and others, 21%). He was treated successfully with intraperitoneal cefazolin, a first generation cephalosporin, for 2 weeks.


Erysipelothrix rhusiopathiae peritonitis in a patient undergoing continuous ambulatory peritoneal dialysis.

Shin SJ, Gwak WG - J. Korean Med. Sci. (2010)

III-demarcated erythematous, violaceous macules especially on the dorsum of right index finger.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2908798&req=5

Figure 1: III-demarcated erythematous, violaceous macules especially on the dorsum of right index finger.
Mentions: Four days before he visited the hospital, he sustained a small lacerated wound on his right index finger while trimming the nail, but did not seek care. The next day, he had mild abdominal pain, loose stools, and several bullous skin lesions that progressed from the right hand and forearm to the back area. He claimed that the exchanged CAPD fluid was clear. He thought the symptoms might be due to food poisoning because he ate raw fish the day before the symptoms developed. When he sought evaluation at our hospital, the vital signs were stable and he was afebrile. The initial bullous skin lesions that he described had almost resolved and were replaced with erythematous, violaceous macular lesions (Fig. 1). There was a diffuse abdominal tenderness, but without signs of peritoneal irritation. The CAPD fluid was slightly turbid. Both first and third generation cephalosporins were administered intraperitoneally according to the hospital recommendation for CAPD peritonitis. The initial cell count of the peritosol showed a white blood cell (WBC) of 1,600/µL (polycytes, 70%; lymphocytes, 12%; and others, 18%) with no red blood cells. Gram positive rods were demonstrated on gram stain. At the next visit on day 3, the abdominal pain was markedly improved. As a causative pathogen, E. rhusiopathiae was identified by a GNI-plus card with a Vitec II compact system (BioMeriux, Marcy-I'Etoile, France). The colonies on the blood agar plate were small and transparent, showing negativity for catalase, oxidase, and methyl red. On slants of triple sugar iron (TSI) agar, hydrogen sulfide was detected as a black precipitate. E. rhusiopathiae showed antibiotic susceptibility to cephalosporins, penicillin, erythomycin, and clindamycin, but resistance to vancomycin. The repeat examination of the CAPD fluid showed a WBC count of 42/µL (polycytes, 4%; lymphocytes, 17%; and others, 21%). He was treated successfully with intraperitoneal cefazolin, a first generation cephalosporin, for 2 weeks.

Bottom Line: He was suffered from mild abdominal pain with a distinctive erysipeloid skin lesion.E. rhusiopathiae was considered to be introduced through a lacerated wound on his hand when he was exposed to contaminated materials.He was treated successfully with a first generation cephalosporin.

View Article: PubMed Central - PubMed

Affiliation: Department of Internal Medicine, Dongguk University Ilsan Hospital, Goyang, Korea. shine@duih.org

ABSTRACT
Erysipelothrix rhusiopathiae is known as a pathogen of occupational diseases or a zoonosis. We report a case of E. rhusiopathiae peritonitis in a 50-yr-old male undergoing continuous ambulatory peritoneal dialysis (CAPD). He was suffered from mild abdominal pain with a distinctive erysipeloid skin lesion. E. rhusiopathiae was considered to be introduced through a lacerated wound on his hand when he was exposed to contaminated materials. He was treated successfully with a first generation cephalosporin. To our knowledge, CAPD peritonitis due to E. rhusiopathiae is very rare, and this is a report of the first case in Asia.

Show MeSH
Related in: MedlinePlus