A 44-year-old male, born in Mali, who came to the emergency department with a six-hour history of fever and malaise.
As a background of interest, Graves-Basedow disease should be highlighted, which was being treated with isoniazid 30 mg/day for 6 weeks and the extraction of the lower third molar for four days.
The physical examination showed Ta 39.5oC, TA 122 CF 137 l/min.
Caries in several teeth and redness in the tooth extraction area are observed in the mouth. The rest of the exploration is anodyne.
Blood analysis showed 500 leukocytes/mm3 (0% neutrophils) with the rest of the normal series, CRP 321 mg/dL, normalized thyroid function and no other relevant data.
Samples of urine, sputum and blood were taken for microbiological study and began with broad-spectrum antibiotic treatment (amikacin 20 mg/Kg/day and cefepime 2 g/8 hours).
In the bone marrow study that was performed the following day, hypercellularity was detected with maturation arrest in myeloid series, without other relevant data, of probable pharmacological etiology, so treatment was discontinued Gazol/kg.
During the first three days of admission, the patient had two episodes of fever of 39, which on the fourth day was changed to meropenem 1 g/8 hours and echocardiography was performed for transesophageal endocarditis using 400 mg/day.
On the fifth day, fever disappeared, resulting in partial recovery of neutrophils at 1,800/mm3, and on the seventh day the patient was discharged due to favorable evolution and resolution of the condition.
At 18 hours in atmosphere isolation was detected in aerobic and anaerobic hemocultives the growth of a gramnegative bacillus that is subsequently subcultured in different solid media in aerobiosis, CO2.
After 48 hours, Columbia Agar, Chocolate Agar and Brucella Agar (not McConkey medium) grew pale yellow colonies, with agar cochlorite embedded.
These colonies were oxidase positive, catalase negative, urease and indole negative, reduced nitrate to nitrites and did not affect carbohydrates.
In the susceptibility study performed in parallel by the Kirby-Bauer method with muxoxime sensitive plates tested against muciximaminton blood and with ciprofloxacin cefuroxifloxacin ampicillin + cefurazol, all strains tested against amoxicillin
Their identity was confirmed by 16s gene sequencing.
