Spontaneous bacterial peritonitis due to Corynebacterium sp.

Spontaneous bacterial peritonitis due to Corynebacterium sp Sir, Spontaneous bacterial peritonitis is a common complication of alcoholic liver cirrhosis and is usually caused by Gram-negative bacilli.' We report such a case due to Corynebacterium sp. An 80-year-old woman with a history of alcoholic liver cirrhosis and ascites was transferred to our hospital because of change in mental status and worsening ascites. Her medical history was significant for placement of a Denver shunt several months ago. On admission she was responsive only to painful stimuli. Her vital signs were: temperature 98°F, pulse 120 beats/min, blood pressure 135/85 mmHg. Examination of the neck showed a raised jugular venous pressure on the right and a palpable Denver shunt on the left. Her lungs were clear on auscultation and the heart examination was remarkable only for tachycardia. The abdomen was markedly distended with several dilated veins and there was no tenderness or rebound. Fluid thrill and shifting dullness were both present. Laboratory data showed a white cell count of 11 x I09/1 with 80% neutrophils. An abdominal paracentesis was done which yielded 1500 ml of cloudy fluid with a white cell count of 4 x 109/l with 84% neutrophils. The Gram staining showed +4 white cells and a few Gram-positive bacilli. She was started on ampicillin/sulbactam 3 g intravenously (iv) 6 hourly. Culture grew Corynebacterium sp sensitive to penicillin, cephalorosporins and vancomycin; speciation was not done due to technical difficulties. On the third day of antimicrobial therapy the patient improved markedly and became alert and oriented. Because of refractory ascites the old Denver shunt was removed and a new one inserted. Soon after the procedure the patient developed disseminated intravascular coagulation. On day 16 she developed another episode of spontaneous bacterial peritonitis due to highly resistant Kiebsiella pneumoniae and was started on imipenem/cilastatin 500 mg iv 8 hourly. The same organism also grew from blood. Despite antibiotic and other supportive care she continued to deteriorate and died on the 23rd day of hospitalisation because of upper gastrointestinal haemorrhage. Corynebacteria are Gram-positive, non-spore-forming rods and are considered com-mensals of human skin and nasopharynx. However, they have recently been reported as pathogens in a number of infections including erythrasma, pneumonia, endocardi-Summary points * spontaneous bacterial peritonitis usually occurs in patients with cirrhosis of liver * Gram-negative bacilli are the usual causative agents * Corynebacterium sp is an extremely rare cause of spontaneous bacterial peritonitis * prognosis …