Kingella kingae is a commensal of the upper respiratory tract that occasionally causes skeletal infections in children and endocarditis in children and adults. We report a case of a 55-year-old man with liver disease and tense ascites who performed a paracentesis on himself and developed K. kingae peritonitis and bacteremia.
CASE REPORTA 55-year-old man with a history of advanced hepatic cirrhosis related to hepatitis B and C and of past alcohol and intravenous drug use developed progressively worsening abdominal distension, diffuse abdominal pain, and dyspnea with exertion over a 4-week period. To relieve these symptoms, he procured a syringe with a needle and inserted it into his umbilicus, draining enough yellow fluid to soak three shirts. He felt better initially, but 3 days later, he noticed that the injection site was tender and red and his abdomen was more painful and distended. His brothers brought him to the emergency department because he was more confused than usual. At the time of presentation he reported fevers and chills but no headache, rhinorrhea, sore throat, cough, dysuria, or change in bowel habits. He was not actively using drugs or alcohol and had been compliant with his medications, which included a proton pump inhibitor, diuretics, and lactulose. When asked about the needle which he had used for paracentesis, he reported that he had taken it from a hospital and that it was not wrapped in a sterile package but did have an intact needle cap in place.On examination, the patient was febrile (100.5°F) but hemodynamically stable. He was in mild distress due to dyspnea and abdominal pain. His sclerae were icteric, and his mucous membranes were dry, but there were no oral ulcers or pharyngeal erythema. The patient was edentulous. The heart sounds were regular, and there were decreased lung sounds at the bases. The abdomen was firm, distended, and diffusely tender. The umbilicus was erythematous, tender, and indurated, but there was no discharge. Mild edema of the lower extremities was noted, and there were a few spider angiomata on the skin of the upper chest. Asterixis was present on neurological exam.On admission, the peripheral leukocyte count was 19,300/mm 3 with 89% neutrophils and 8% band forms. The platelet count was 103,000/mm 3 . The serum creatinine level was 1.7 mg/dl, and the sodium level was 120 mmol/liter. The total bilirubin was elevated at 8.1 mg/dl, as were alanine aminotransferase and aspartate transaminase (113 and 225 U/liter, respectively) and international normalized ratio values (1.7). The clinical impression was one of acute decompensation of severe underlying chronic liver disease. Since these events are often triggered by infections, specimens of blood, urine, and peritoneal fluid were submitted for culture before he was started on antibiotics: ceftriaxone and vancomycin.A large volume of peritoneal fluid was removed (5.5 liters), and a sample sent for analysis showed a white blood cell count of 5,725/mm 3 with a differential of 87% neutrophils and 8% lymphocytes. Gram st...
