A 66‐year‐old woman presented with 3 days of shortness of breath. He also reported a productive cough, fever, and chills. Prior to 3 days the patient reported no dyspnea and reported excellent exercise tolerance. Reported improvement with albuterol and worsening with laying flat. She denied any sick contacts. She had a medical history significant for diabetes, hypertension, high cholesterol, and hypothyroidism. She reported smoking a pack a day for 20 years, quitting the week of admission. She denied any illicit drugs or alcohol abuse. Her family history was positive for lung cancer. On presentation the patient's vital signs were notable for an elevated temperature to 101.7°F, tachycardia to 105 beats per minute, and oxygen saturation of 88% on room air. The physical exam was remarkable for diffuse wheezing and decreased airflow bilaterally. Her complete blood count was normal. Electrolytes and liver function tests were normal, except for a low serum sodium and albumin. Chest X‐ray demonstrated right middle lobe air‐space disease. Blood cultures demonstrated gram‐negative coccobacilli consistent with Pasteurella multocida. On further questioning the patient stated she lived in a small trailer with multiple pet cats.
Community‐acquired pneumonia is a common illness, affecting 1 of 1000 adults each year. Streptococcus pneumoniae is the most common cause of pneumonia. Pasteurella multocida is a rare but important pathogen to consider in the differential of community‐acquired pneumonia. The bacterium is normally found in the upper respiratory tract of birds and mammals, especially healthy cats and dogs. It commonly causes soft‐tissue and bone infections after exposure via animal bites or scratches. In patients with COPD, the bacterium is known to cause serious upper and lower respiratory tract infections, commonly pneumonia. Bacteremia is commonly found with associated pulmonary infection. Mortality can be as high as 29%. Patients generally present with nonspecific symptoms of fever, malaise, shortness of breath, and pleuritic pain. Wheezes and rhonchi are commonly heard on exam, and chest X‐ray commonly reveals lobar consolidation, although a diffuse or multilobar exam can be seen. The organism can be isolated from the blood or respiratory secretions. The organism responds to many of the antibiotics, including quinolones, cephalosporins, and macrolides, but susceptibility testing needs to be completed to ensure susceptibilities. Most of the common features of Pasteurella infection as well as exposure to cats were found in our patient. Her rapid onset of symptoms and the severity of her symptoms with her associated COPD were also typical of this infection. However, the lack of a report of a companion animal prevented consideration of this diagnosis.
The patient was successfully treated with levofloxacin and slowly weaned off respiratory support to room air.
L. Richey, none.