Case Presentation: A case of Pasturella multocida infection, which manifested as sepsis, endopthalmitis, and native mitral-valve endocarditis, in an older patient on imatinib for a recently diagnosed gastrointestinal stromal tumor (GIST).
Discussion: The patient is a 71-year-old female with a history of HTN, DM, HLD, mitral valve stenosis, and GIST on gleevec, who presented in the ED with acute onset left hip, flank, and shoulder pain, and right dorsal foot pain, starting two days prior to admission. There was no reported trauma or associated symptoms. She also described acute blurred right vision for two days, with pending cataract surgery in that eye. She was septic in the emergency department, with flank pain and urinalysis indicative of a urinary tract infection, leading to a suspicion of pyelonephritis, and was given ceftriaxone. The following morning, patient had an engorged, pus-filled right eye with complete loss of vision. Opthalmology was consulted, and suspicious for bacterial endopthalmitis was high. Given suspicion of septic emboli, patient went for a transthoracic echocardiogram which revealed increased mitral regurgitation, and a transesophageal echocardiogram, which revealed a 0.6 cm x1.1 cm mobile echodensity on the mitral valve. Blood cultures subsequently grew Pasturella multocida, and on further history, she admitted to a domestic dog bite three days prior to this admission. The wound was cleaned in the ED without antibiotic administration. She had a mitral valve replacement, with her course complicated by acute renal failure from acute tubular necrosis, right pleural effusion, and bilateral upper extremity deep venous thromboses. She required right eye evisceration as an outpatient.
Conclusions: Pasturella multocida is a rare cause of endopthalmitis and endocarditis, and the combination of symptoms is especially rare. Slightly over 30 cases of P. Multocida endocarditis have been reported worldwide. Left-sided P. multocida endocarditis is associated with a high mortality (30%). Lethal outcome from P. Multocida sepsis is seen in 37% of patients. Endopthalmitis from P. multocida is significantly rarer, with cases describing both complete eye evisceration and preserved vision. To our knowledge, no cases have been reported with a patient having both complications. Given that pet owners are at higher risk, as are those with immunocompromised states, primary care providers should provide education to any appropriate patient who presents following exposure from cat or dog bites, or wound exposure to saliva from those animals.