Capnocytophaga canimorsus Septicemia With Sepsis-Induced Coagulopathy and Endocarditis

Abstract

Capnocytophaga canimorsus is a rare cause of serious infections with a high mortality of 10% to 30%. It is usually found in the oral cavity of cats and dogs and can cause severe sepsis in immunocompromised patients. An 81-year-old female Caucasian patient presented with C. canimorsus sepsis after a dog bite in her finger three days before presentation to our emergency department. She initially was presented to us with sepsis, thrombopenia, and schistocytes in her laboratory findings, suggesting the differential diagnoses of the multiple subtypes of thrombotic microangiopathy. She was admitted to the medical intensive care unit of the University Hospital of Saarland because of septic shock with circulatory insufficiency. The patient received plasmapheresis, antibiotics, and dialysis, under which she improved significantly. The fingertip of the affected finger developed necrosis and had to be amputated. Furthermore, the patient was diagnosed with a mitral valve endocarditis, a very rare complication of C. canimorsus infection. It was treated conservatively with antibiotics and was no longer detectable 8 weeks after the diagnosis. Surgical intervention was not needed. The case describes well that it is still difficult to distinguish between thrombotic thrombocytopenic purpura (TTP), disseminated intravascular coagulation (DIC), and sepsis-induced coagulopathy (SIC), especially in the early phases of acute disease, especially in C. canimorsus-induced sepsis.

Keywords: Capnocytophaga canimorsus; disseminated intravascular coagulation; sepsis; sepsis-induced coagulopathy; thrombotic microangiopathy.

Figure 1

(a) Finger D3 of the right hand at admission and (b) finger D3 of the right hand one day after admission.

Figure 2

Mottling of the patient's legs on admission (mottling score 4).

Figure 3

(a) Endocarditic lesion (4 × 5 mm) on the anterior mitral valve leaflet in the transesophageal view and (b) transesophageal echocardiographic control 8 weeks after diagnosis of endocarditis without detection of vegetation on the mitral valve.