| Popis: |
An 88-year-old male presented to our hospital with a week-long history of fever (up to 38°C), shivering, and general weakness. On arrival, clinical status indicated a blood pressure of 150/90mmHg, heart rate of 130/min, respiratory rate of 26/min, and 39, 3°C temperature. Auscultatory crepitations were heard upon the lung bases. He suffered from periodontitis and had some extremely carious teeth. The rest of the status was regular. The patient was SARS CoV-2 negative, and laboratory findings revealed: CRP 82, 6 mg/L, procalcitonin 3, 50 μg/L, leucocyte count 9, 1×10 9 /L with neutrophilia of 95, 1%, slight anaemia (Hb 104 g/L), elevated d-dimers 4, 26 mg/L, potassium 3, 5 mmol/L, glucose 7, 9 mmol/L, serum proteins 56 g/L, albumin 30, 8 g/L, hs-troponin 1, 08 ng/L, NT- pro-BNP 858 ng/L and fibrinogen 6, 1 g/L ; while other routine test results were normal. MSCT of the abdomen showed an infiltrative/proliferative abdominal mass, 8 cm in diameter, with inflammatory characteristics, attached to the lienal flexure of the colon. Nevertheless, the blood culture was positive, and Actinomyces odontolyticus was identified. On the 15th day of the illness, three carious teeth were extracted. On the 19th day, a colonoscopy shoved intraluminal neoplasm of lienal colonic flexure and the histopathological findings revealed adenocarcinoma. On the 55th day, a left hemicolectomy with latero-lateral end anastomosis was performed. The 44-day parenteral antibiotic treatment started with piperacillin/tazobactam, followed by the penicillin G, then linezolid (due to nosocomial cellulitis of the left hand), ceftriaxone, and finally meropenem and linezolid combination (due to an early postoperative wound infection). Oral amoxicillin therapy was continued for six months after discharge. On the follow-up (33rd postoperative day), the patient was well and symptom-free. In the case of Actinomyces odontolyticus sepsis, dental treatment is required. If a concomitant intra- abdominal mass is found, a colonoscopy should be performed to exclude an underlying chronic intestinal pathology. |
