Survival of community-acquired Bacillus cereus sepsis with venous sinus thrombosis in an immunocompetent adult man - a case report and literature review

Abstract

Background: Bacillus cereus infections in immunocompetent patients are uncommon and mainly observed in fragile patients. It can cause lethal infections with multiple organ dysfunction syndrome (MODS). However, a patient presenting as venous sinus thrombosis and survival without sequela has not been reported.

Case presentation: A 20-year-old previously healthy male developed gastroenteritis after a meal, followed by fever, convulsions, and severe disturbance of consciousness. The patient had significant leukocytosis with a mildly elevated D-dimer, creatinine level, and respiratory failure. The CT(computed tomography) revealed fatal brain edema and subarachnoid hemorrhage. Previous blood culture in a local hospital revealed B. cereus, which was confirmed by mNGS(metagenomic next-generation sequencing) using blood and urine in our hospital. Accordingly, B. cereus sepsis with MODS were considered. Later, cerebral venous sinus thrombosis was proved. After anti-infection (linezolid 0.6 g, Q12h; and meropenem 1.0 g, Q8h), anti-coagulant (enoxaparin 6000U, Q12h), and other symptomatic treatments, the patient recovered completely without sequela at the 6-month follow-up.

Conclusions: This case suggests that in immunocompetent adults, there is still a risk of infection with B. cereus, causing severe MODS. Special attention should be paid to venous sinus thrombosis and subarachnoid hemorrhage in such cases, while, anti-coagulant is essential therapy.

Keywords: Bacillus cereus; Sepsis; Venous sinus thrombosis.

Fig. 1

Radiographic findings of the patient. A-B showed cerebral edema and subarachnoid hemorrhage by cranial CT in local hospital; C-D showed local edema and thickening of the ascending colon wall with peritoneal thickening by abdominal CT plain scans in our hospital; E–F showed aggravated cerebral edema and subarachnoid hemorrhage by CT One day later; G-H showed significantly aggravated cerebral edema and multiple subarachnoid hemorrhages by CT After 12 days; I showed fine contrast in the left transverse sinus, sigmoid sinus and the opposite side of the internal jugular vein, and less uniform local density of transverse sinusAfter 12 days; J ~ K showed alleviated cerebral edema and subarachnoid hemorrhage after 2 weeks

Fig. 2

mNGS results of the patient. A. The DNA reads positions of B. cereus and the content of detected microbes by blood mNGS. The coverage of B. cereus detected by blood mNGS was 0.0361%. B. The DNA reads positions of B. cereus and the content of detected microbes by urine mNGS. The coverage of B. cereus detected by urine mNGS were 0.0081%

Fig. 3

Timeline for the reported case