Diagnostic Dilemma: A Sticky Situation


A 37-year-old man from Thailand, visiting his son in the U.S for the past 3 days presents with abdominal pain and distention, fevers and rigors going on for the past 2 days and worsening. His son takes him to his local ER, where imaging shows the presence of a large 5 cm liver abscess. In addition to being febrile, he is also noted to be hypotensive and having rigors. He is started on broad-spectrum antibiotic therapy and given intravenous fluids. Prior to this, blood cultures are obtained, which grow a Gram-negative rod. He continues to worsen, and so he is taken to the OR. There, his abscess is drained and cultures are obtained, along with Gram stain, fungal stain/cultures and AFB stain/cultures. Stains are all negative. Cultures on blood agar however start growing very sticky colonies that adhere to the surface of a Q-tip.

Of note, the patient works as a veterinarian, and has treated dogs, cats and a sheep recently. His cousin was being treated for pulmonary TB. He drinks 1-2 beers a day, and smokes 1/2 PPD but denies intravenous drug use. He lives near a river but has not swam in it, although he does fish there at times. Labs show a Hgb of 11.7, WBC of 14, platelets of 500,000. AST is 57, ALT is 101, alkaline phosphatase is 47, total bili is 0.7. Cr is 1.1 mg/dL. HIV testing is negative. He has lost 15 lbs. in the last month, in addition to the above mentioned symptoms.

What is the most likely underlying causative organism associated with his above symptoms?

  1. Pseudomonas aeruginosa
  2. Aeromonas species
  3. Klebsiella species
  4. Mycobacterium tuberculosis
  5. Echinococcus granulosus
  6. E.coli


Answer later this week!

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