Spooky Case Report

The following case report was inspired by a patient. The gender, age, and race have been left out to protect patient personal health information. This case report is intended to have a discussion and learning opportunity about an unusual diagnosis. This case report is not intended to be medical advice, contact your physician for medical advice.

Disclaimer

Patient states significant other had the same symptoms for a week and was found dead this morning.

Chief Complaint:

Abdominal pain, nausea and fever for three days 

ED Diagnosis:

Dehydration, fever (101.4) anorexia, gastroenteritis, pneumonia, hypokalemia, hyponatremia, leukocytosis, SIRS and abdominal pain

Treatment:

Tylenol, potassium IV replacement, zosyn + vanco loading dose, two liter NS bolus

Remarkable labs:

WBC 26, Na 129, K 2.8, Cl 88, ALT/AST 100/238

Admitting Physician

Ordered ID consult and the following lab test:

  • Legionella
  • Strep pneumonia
  • Blood cultures
  • Stool cultures
  • Hepatitis panel 
  • Repeat BMP

Plan:

Continue zosyn 3.375 g q8hrs extended infusion protocol, continue Vanco dosing per pharmacy and added flagyl. Keep patient hydrated with Normal Saline with 20 mEq KCL at 75 ml/hrs

Infectious Disease Physician

Day 1: Patient is presenting with an atypical CAP. Respiratory panel was PCR negative, but there’s concern for opportunistic microorganisms (pneumocystis or Cryptococcus) due to patient chronic malnourishment. 

Plan: Added procalcitonin, LDH, beta D glucan and cryptococcal antigen lab test. Continue zosyn, vanco and flagyl. 

Day 2: The following lab test have come back negative: HIV, hepatitis panel, cryptococcal antigen, blood cultures and urine cultures negative for two days. 

Plan: Ordered bronchoscopy and BAL to clarify the etiology of the lung disease. If MRSA negative DC vanco. DC flagyl and added Bactrim. 

Day 3: Patient was intubated for the bronchoscopy and kept on vent support due to worsening respiratory failure. Patient was placed on rotaprone bed and was maxed out on sedatives and paralytics to tolerate the bed. Microbioloy studies show lophomonas. 

Plan: MRSA lab test was negative, therefore DC Vanco + Bactrim. Keep patient on flagyl and cefepime.

What is lophomonas?

Lophomonas blattarum is a protozoan that usually parasitizes in the intestinal tracts of termites and cockroaches. It can cause infections in a variety of tissues and organs, including the maxillary sinus and other sinuses, lungs, reproductive system, and respiratory tract. So far, L. blattarum human infections occur mainly in China. 

How is it diagnosed and treated?

This protozoan parasite was identified by bronchoscopic brush smears, bronchoscopic biopsy smears, or bronchoalveolar lavage (BAL), and the patient was treated with metronidazole or tinidazole, with good prognosis.

              

                


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