A fatal non-01 Vibrio cholerae septicemia in a patient with liver cirrhosis.

ibrio Cholerae (V. cholerae) strains are usually divided into O1 and non-O1 serogroups according to the different antigens that they synthesize.1 Vibrio cholerae species cause gastrointestinal infections (especially O1), or extra intestinal infection (particularly non-O1). There has been several reports of bacteremia and other septic conditions associated with non-O1 V. cholerae, many of these infections have followed a fatal course, presenting as a fulminant septicemia in patients with liver diseases, who had ingested raw or undercooked seafood.2 In this report, we present the case of a Saudi male with Lawrence Moon Biedl syndrome, cirrhosis and diabetes mellitus (DM), who developed fatal septicemia caused by non-O1 V. cholerae. A 34-year-old Saudi male, known patient of Lawrence Moon Biedl syndrome, DM, liver cirrhosis and positive hepatitis B virus, was admitted through the Emergency Room to the medical unit of King Abdul-Aziz University Hospital with diarrhea, abdominal pain and distention of 10 days duration. On physical examination, he was alert, icteric, with a temperature of 36.3oC, heart rate of 84 beats/minute, and blood pressure of 129/71mm Hg. Ascites was present with abdominal tenderness. The patient was treated with osteocare one tablet po od, essential one tab po od, legolon 70mg tid, motilium 10mg tab po tid, pentazole 20mg one tablet bid and ceftriaxone one gram intravenously (IV) bid. A specimen of stool was sent for culture. The patient was stable until 2 weeks after admission when he became febrile with a temperature of 38.6oC. A blood was obtained for culture. Upon questioning, the family of the patient revealed that he had eaten uncooked seafood when he spent the weekend at home with the family with permission from the hospital. The patient started vomiting a coffee-ground vomitus, an urgent endoscopy was carried out where a first degree not bleeding esophageal varices was found, in addition to severe gastritis and duodenitis and multiple gastric erosions. He was then treated with amoxil one-gram po bid and clarithromycin 500mg po bid in addition to the pentazole he was already taking. The patient developed a progressive abdominal swelling, abdominal and epigastric pain over the next 2 days, with difficulty in breathing. A spontaneous bacterial peritonitis was diagnosed clinically, and diagnostic paracentesis was carried out and yielded 3100/mm3 of a yellowish turbid V Clinical Notes