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Escherichia coli myonecrosis in alcoholic cirrhosis
Vivian Levy1, Catherine Reed, Sharon L Abbott
1Stanford University School of Medicine, Division of Infectious Diseases and Geographic Medicine, California 94305, USA. vlevy@stanford.edu
Abstract:
The risk of bacteremia in patients with cirrhosis increases with more advanced Child classification. Escherichia coli is the most frequently implicated organism in these bacteremic episodes. Unusually, E. coli can produce a bullous cellulitis or myonecrosis. Two previous cases of E. coli-associated myonecrosis in patients with cirrhosis have been reported. We describe a third case in a cirrhotic patient with E. coli-associated bilateral lower extremity gas gangrene and review the existing literature. In the three patients with cirrhosis and E. coli myonecrosis, no obvious gastrointestinal perforation was found as the source of bacteremia. Intestinal edema due to portal hypertension is thought to have facilitated mucosal microperforations and bacteremia. Awareness of this unusual presentation may facilitate earlier diagnosis.
Insights
Patients with cirrhosis face higher bacteremia risks, especially from Escherichia coli. This bacterium can cause severe conditions like gas gangrene, even without obvious gastrointestinal issues, highlighting a critical diagnostic challenge.
Area of Science:
- Infectious Diseases
- Hepatology
- Critical Care Medicine
Background:
- Bacteremia risk escalates with cirrhosis severity (Child classification).
- Escherichia coli is a common pathogen in cirrhotic bacteremia.
- E. coli can manifest as unusual skin and soft tissue infections.
Observation:
- A case of E. coli-associated bilateral lower extremity gas gangrene in a cirrhotic patient is presented.
- Previous literature includes two similar cases of E. coli myonecrosis in cirrhosis.
- No gastrointestinal perforation was identified as the source of bacteremia in these cases.
Findings:
- Portal hypertension-induced intestinal edema may lead to mucosal microperforations.
- These microperforations can facilitate E. coli bacteremia.
- E. coli can cause severe myonecrosis, including gas gangrene, in cirrhotic patients.
Implications:
- Increased awareness of E. coli's potential for severe soft tissue infections in cirrhosis is crucial.
- Early recognition of gas gangrene in cirrhotic patients can improve outcomes.
- Understanding the pathogenesis via intestinal edema aids in managing bacteremia risk.