Case Presentation: A 47-year-old male with past medical history of HIV controlled on Biktarvy (CD4 >1000, reportedly negative HIV viral load) and mild substance use disorder (multiple substances, snorting, denied IV use) presented to the hospital with acute chest pain. The pain was present in the midsternal region, described as “sharp,” and was associated with shortness of breath. Review of systems was positive for dysuria, and he endorsed recent unprotected sex. Admission vital signs were unremarkable, and his physical exam was without notable findings. His electrocardiogram revealed left ventricular hypertrophy with early repolarization changes. High sensitivity troponins were negative (7ng/L followed by 7ng/L). An echocardiogram was grossly normal. Labs were significant for an elevated white blood cell count to 17.4B/L. A urine drug screen was positive for cocaine. Blood cultures and urine gonorrhea were collected however, he was discharged from the emergency room given his negative cardiac work up for chest pain. He was empirically started on doxycycline. His blood cultures grew Campylobacter fetus 24 hours later, and his urine gonorrhea was positive; he was asked to return to the hospital.
Discussion: On return to the hospital, he endorsed diarrhea. He was treated for gonorrhea with ceftriaxone. Infectious disease was formally consulted. The patient had three additional sets of blood cultures drawn one hour apart. These cultures remained negative throughout his hospitalization, although possibly due to partial treatment of the Camplyobacter species with doxycycline. He was started on ampicillin-sulbactam and azithromycin. Due to the increased risk of vascular involvement with this species of Campylobacter and his presenting symptoms of chest pain, a CT chest was obtained due to his recent chest pain. CT revealed an ascending aorta which was top normal size in diameter but without thickening of the aortic arch or dissection. The source of the infection was unclear, as he denied recent travel, animal exposures, sick contacts, or eating raw/undercooked food. He was sexually active with a male partner who was not exhibiting symptoms. He ultimately completed a 21 day course of amoxicillin and clavulanic acid and doxycyline (rather than azithromycin to cover for possible concurrent Chlamydia in the setting of gonorrhea infection).
Conclusions: Campylobacter fetus is a rare cause of infection in humans. It more frequently causes bacteremia than other Campylobacter species. Immunocompromised patients are more frequently infected, although it can cause a self-limited enteritis in immunocompetent patients. C. fetus is endemic in animals such as cattle and sheep, which may represent the human reservoir. There have also been cases identified in men who have sex with men, suggesting a possible avenue for human-to-human transmissibility. C. Fetus is known to cause endovascular disease, such as endocarditis and mycotic aneurysms. There are currently no trials that address the duration of therapy, and it may cause persistent or relapsing disease.