Superior mesenteric artery (SMA) syndrome is a rare acquired disorder in which acute angulation of SMA causes compression of the third part of the duodenum between the SMA and the aorta, leading to obstruction. Loss of fatty tissue as a result of a variety of debilitating conditions is believed to be the etiologic factor causing the acute angulation. We report a case of an 86-year-old man with prolonged congestive heart failure and aortic stenosis in which SMA syndrome developed as a result of cardiac cachexia. Because of poor functional status and comorbidities, he was not a suitable candidate for decompressive surgery. Conservative treatment using a gastrostomy tube with jejunal extension led to improvement in nutritional status and resolution of symptoms.

Bordetella bronchiseptica is an uncommon cause of respiratory infection in humans generally occurring in immunocompromised individuals exposed to infected animals. A 61-year-old female underwent a kidney-pancreas transplant 7 years before presentation. Postoperative immunosuppression was achieved with sirolimus and mycophenolate mofetil. The patient was doing well until she developed a small bowel obstruction secondary to adhesions. She underwent surgical adhesiolysis without complications. Two weeks postoperatively the patient developed pneumonia. She failed to respond to repeated courses of antibiotics, and thus, diagnostic bronchoscopy with bronchoalveolar lavage (BAL) was performed. BAL cultures grew B. bronchiseptica. Further investigation revealed that the patient's dogs had recently received a live-attenuated B. bronchiseptica intranasal vaccination. The patient recovered after 21 days of therapy with doxycycline based upon in vitro susceptibility testing. B. bronchiseptica is an uncommon but recognized human pathogen. It most commonly affects immunocompromised individuals. Here, we report a culture-proven case of B. bronchiseptica pneumonia in an immunocompromised host residing in a household with her dogs who had recently received live-attenuated, intranasal B. bronchiseptica vaccinations. As polymerase chain reaction testing was not performed comparing the isolated strain to the vaccination strain, the association is presumptive. This report expands the spectrum of immunocompromised hosts to include renal-pancreas transplant patients who have developed infection from B. bronchiseptica, while illustrating the risks associated with animal contacts and attenuated vaccines in the immunosuppressed population.

Superior mesenteric artery (SMA) syndrome is a rare acquired disorder in which acute angulation of SMA causes compression of the third part of the duodenum between the SMA and the aorta, leading to obstruction. Loss of fatty tissue as a result of a variety of debilitating conditions is believed to be the etiologic factor causing the acute angulation. We report a case of an 86-year-old man with prolonged congestive heart failure and aortic stenosis in which SMA syndrome developed as a result of cardiac cachexia. Because of poor functional status and comorbidities, he was not a suitable candidate for decompressive surgery. Conservative treatment using a gastrostomy tube with jejunal extension led to improvement in nutritional status and resolution of symptoms.