Cat Exposure Leading to a Rare Pasteurella Multocida Endocarditis

Abstract

is an extremely rare entity, with only a few cases reported in the literature. CASE PRESENTATION: A 64-year-old man with history of Monoclonal Gammopathy of Undetermined Significance (MGUS), aortic valve stenosis s/p bioprosthetic aortic valve (BPAV), and sick sinus syndrome s/p pacemaker (PM), presented with altered mental status. Vital signs showed a blood pressure of 71/34 mm Hg, heart rate of 128 beats per minute, and respiratory rate of 30. Chest X ray was unremarkable. Bedside ultrasound didn't show tamponade. WBC was 43.3 k/mm3 and lactic acid was 6.6 mmol/ L. We presumed this was septic shock. He required multiple vasopressors. He was given Vancomycin and Cefepime. He had multiorgan failure requiring mechanical ventilation and hemodialysis (HD). CT Chest/Abdomen/Pelvis w/o contrast was unremarkable. Blood cultures grew P. multocida in 4/4 bottles. His wife stated they adopted a cat 8 weeks prior. Antibiotic was switched to Ceftriaxone after susceptibilities returned. Transthoracic echocardiogram showed a vegetation on the PM lead. Subsequent transesophageal echocardiogram (TEE) confirmed the vegetation on the PM lead, while the BPAV appeared normal. The entire PM was then removed, but patient continued to have persistent fever. Given persistent fever, a repeat TEE was performed (two weeks after the 1st TEE), which now showed a large, 1 cm x .74 cm vegetation on the BPAV. A multidisciplinary team made the decision to not surgically intervene immediately and to complete a full antibiotic course first. Multiple repeat blood cultures after the initial positive culture were all negative. His lab values improved, was extubated, and no longer required HD. TEE after completion of 8-week antibiotic course demonstrated no vegetation on the BPAV, suggesting positive response from antibiotics. He did not recall suffering from any scratch or bite from his cat.