Shock following a cat scratch

A 49-year-old man with fever, pain in both legs, purpuras and cyanosis was admitted to hospital. He was a heavy drinker, but did not have diabetes or other immunosuppressive disease. On admission, he was in shock, with haematological findings suggestive of disseminated intravascular coagulation, and liver and kidney failure. The presence of a scratch wound on his face caused by a cat, and linear, Gram-negative rods phagocytosed by polynuclear leucocytes on peripheral blood smear suggested Capnocytophaga canimorsus infection. On day 1, antibiotics (ampicillin/sulbactam) and catecholamines were initiated. The patient required haemodialysis three times per week for 3 weeks. His toes became necrotic but improved and amputation was not necessary. On day 52, he was discharged from hospital with only mild sensory impairment of the legs.