85 year old man with a history of subtotal gastrectomy for gastric cancer and cholecystectomy in 1996, hip fracture operated in 2003 and untreated hypertension.
In February 2008, being in southern Chile (Puerto Montt), the patient presented a clinical picture of gastroenteritis characterized by liquid stools without pathological elements and with a frequency of 3 to 4 episodes of fever, associated with daily fever.
Diarrhea resolved after 72 hours, but persisted with fever, abdominal pain located in the right hypochondrium, weakness and anorexia for two weeks.
Due to this picture he consulted in the Emergency Service of the Military Hospital of Santiago where it was decided his hospitalization with a diagnosis of febrile syndrome of probable abdominal focus.
The physical examination at admission showed axillary temperature of 37.4 °C, normal blood pressure, normal heart and respiratory rate, adequate hydration and mild pain other relevant findings in the right epigastrium and hypochondrium.
The evaluation was requested by a surgeon and laboratory tests included blood count, erythrocyte sedimentation rate (ESR), biochemical and liver profile, plasma electrolytes, aerobic blood cultures and chest X-ray.
After ruling out a surgical resolution pathology, empirical treatment with intravenous ciprofloxacin 200 mg every 12 hours was initiated.
Hematocrit 33.6%, white blood cell count 29.200/mm3 (neutrophils 82.8%), C-reactive protein 15.81 mg/dL (normal glycemia: 158-1 mg/dL alkaline phosphatase), alkaline phosphatase
Abdominal ultrasound was normal.
A gram-negative bacillus was developed at 12 hours after admission in hemocultives. This bacillus was identified as "missing" by manual techniques forhaemolyticus (MicroScan®).
The strain was sent to the Instituto de Salud Pública de Chile according to the current standard for monitoring enteropathogens, confirming identification.
Based on bacteriological information, antimicrobial treatment was continued.
The patient was discharged after 14 days with oral ciprofloxacin.
