Elizabethkingia meningoseptica Bacteremia, in a Patient Undergoing Peritoneal Dialysis: a Case Report

Elizabethkingia meningoseptica is an emerging nosocomial pathogen commonly seen in dialysis patients. It is associated with a high mortality rate due to multi-drug resistance. Due to the rare occurrence, our understanding of the overall spectrum of presentation with E. meningoseptica is constantly evolving. We report a case of a peritoneal dialysis patient who was found to have diffuse septic emboli as a sequela of endocarditis and Elizabethkingia meningoseptica bacteremia. Our patient was a 73-year-old female with a medical history of end-stage renal disease on peritoneal dialysis, Zollinger-Ellison syndrome, and malignant carcinoid tumor who presented due to acute mental status change. She was hypotensive with systolic blood pressure in 80 mmHg, tachycardic at around 140 beats/minute with an irregular rhythm. Other labs included leukocytosis, elevated lactate, and procalcitonin. Computed tomography (CT) brain revealed small bilateral cerebellar infarctions. She was started on piperacillin-tazobactam and vancomycin. Blood cultures sent on admission tested positive for multi-drug-resistant E. meningoseptica. Peritoneal dialysis catheter culture taken 3 days into the admission and two subsequent blood cultures taken on day 3 and 6 of the hospitalization were negative. Minocycline was added for dual coverage. MRI brain showed multiple acute ischemic infarcts consistent with septic emboli. A transesophageal echocardiogram revealed mitral valve leaflet vegetation. The patient was managed conservatively due to a poor prognosis. She continued to deteriorate throughout her hospital stay, requiring high vasopressor support, and ultimately died 11 days into the admission. Physicians should keep a high suspicion for E. meningoseptica infection in peritoneal dialysis patients if the clinical condition continues to deteriorate despite adequate use of broad-spectrum antibiotics.