History and background.
A 31-year-old male patient, born and residing in the urban area of the city of Colima, Mexico, with a history of alcoholism since 16 years of age and a diagnosis of ranolulose alcoholic cirrhosis managed outpatiently.
His current disease began two weeks before his last admission, with progressive and painful abdominal distension, fever quantified up to 39°C, ortopnea and general malaise.
Location.
Upon admission, the patient was conscious, well oriented in time and space, blood pressure of 130/70 mmHg, temperature 38°C, deep parotid abdomen with signs of generalized chest discomfort, gestalt telangime signs were found.
Other clinical data included hair with gynecoid distribution, testes and moderate lower limb edema.
Laboratory tests.
Blood count: hemoglobin 10 g/dL, white blood cells 11.000/mm3, 83% polymorphonuclear, platelets 142.000/mm3, serum albumin 3.2 g/L, blood glucose 73 mg/dL alkaline urea 125 mg/dL
Chest X-ray showed bilateral elevation of diaphragms and abdomen diffuse ground-glass image; a liver ultrasound showed a small liver with irregular density images interpreted as areas of fibrosis, discrete portal vein dilation.
Endoscopy revealed esophageal varices grade II, non-bleeding and erosive gastritis.
On the second day of admission, a paracentesis was performed, which showed a turbid peritoneal appearance Gram positive self-reported bacteria, proteins 2.8 g/dL ciprofloxacin sensitive, cells 207/mm3, with 85% polymorphonuclear agar.
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Upon admission, empirical treatment was initiated with intravenous cefoxime/40is, showing worsening in the subsequent 48 h, with an increase in fever up to 40°C, with neurological deterioration, with poor response to stimuli, signs of generalized hypertension.
Considering the isolated microorganism and susceptibility pattern, the scheme was changed to ampicillin and levofloxacin, in addition to oral lactulose, furosemide and digoxin.
There was a decrease in fever, improvement in heart failure and alertness after 4 days with the indicated treatment.
The patient requested voluntary discharge 9 days after admission, dying 8 days later at home, apparently with fever, abdominal pain and mental confusion.
