A 70-year-old male patient, with no known drug allergies, with a history of insulin-dependent diabetes mellitus, orthotopic liver transplantation 3 years earlier due to liver cirrhosis HCV and hepatocellular carcinoma, recurrent cirrhosis due to chronic hepatitis C
She was admitted to hospital due to grade II hepatic encephalopathy.
On physical examination, the patient was conscious, disoriented in time and space, with asterixis ++/++, without fever, normal cardiorespiratory auscultation, ascites grade 2 and knee ++ edema.
The chest X-ray at admission was normal, and in routine laboratory tests there were hemoglobin figures of 10.3 g/dl, hematocrit of 30%, leukocytes of 4,500 x 103 mcl with 70% monomorphonuclear blood glucose, 19% lymphocytes,
Bladder catheterization and peripheral venous line placement were performed.
Three days after admission, the patient had fever (38 oC axillary temperature) and underwent urocultive, venous blood and chest X-ray.
Respiratory auscultation revealed wet biphasic crackles.
The chest X-ray showed an image in the right middle field of alveolar pattern, indicative of pneumonia at this level.
Empirical treatment with cefoxime was started at a dose of 2 g intravenously every 8 hours.
The urocultiva was negative and in the hemocultive there was development of Pantoea agglomerans sensitive to amoxicillin, amoxicillin/clavulanic acid, cefoxime, gentamicin and ciprofloxacin.
After the initiation of empirical antibiotic treatment, the patient did not develop fever, and the pathological image of the chest X-ray revealed the presence of a plaque control performed five days later.
1.
J. Morales Ruiz, M. D. Espinosa Aguilar, M. A. López Garrido, F. Nogueras López and C. Viñolo Ubiña Serviço de Aparato Diges
University Hospital Virgen de las Nieves.
Grenada
