Abstract: SA-PO1022
Shanghai Fever in Los Angeles: A Solid-Organ Transplant Recipient
Session Information
- Transplantation: Clinical - 4
October 26, 2024 | Location: Exhibit Hall, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Transplantation
- 2102 Transplantation: Clinical
Authors
- Urrutia, Andrea Leonor, Universidad de San Carlos de Guatemala Facultad de Ciencias Quimicas y Farmacia, Ciudad de Guatemala, Guatemala, Guatemala
- Olano, Claudia Guadalupe, Harbor-UCLA Medical Center, Torrance, California, United States
- Akram, Sami M., Loma Linda University, Loma Linda, California, United States
Introduction
Shanghai fever is a rare presentation of pseudomonas aeruginosa sepsis. The core symptoms are fever, diarrhea and ecthyma gangrenosum (EG) (1). The enteric disease caused by pseudomonas aeruginosa has been reported in pediatric patients (2,3,4); cases in adults are extremely rare (5). To the best of our knowledge this is the first case report of shanghai fever in an adult solid organ transplant (SOT) recipient. EG frequently occurs in immunocompromised and neutropenic patients (6,7). Sixty percent of EG lesions are in the gluteal perineal region (6,8) and can be overlooked if skin is not thoroughly examined
Case Description
This is a 49-y-old female who had simultaneous pancreas kidney transplant 15 months ago. She presents with oral ulcers, severe diarrhea, which progressed to sepsis followed by gastrointestinal bleeding. She required intensive care support and transfusions. She had perirectal pustular and nodular lesions with central necrosis. Histology was consistent with ecthyma gangrenosum. Tissue cultures grew pseudomonas aeruginosa. A clinical diagnosis of pseudomonas sepsis with ecthyma gangrenosum was made, I.e. shanghai fever
Discussion
This is the first case report of shanghai fever in a kidney transplant patient in a suburb of Los Angeles, California. Shanghai fever is a well described enteric disease due to pseudomonas sepsis in pediatric patients. A PubMed search using the terms, [shanghai fever + adults +case report] revealed only one publication (5). While uncommon, shanghai fever or pseudomonas enteric disease (PED) can occur outside of Asia (8). PED can be fatal and in one case series the mortality was 15% (1). The clinical features of PED cases are fever, diarrhea (enteric illness) and ecthyma gangrenosum (1). Our patient had all components of PED. The differential diagnosis of fever in a immunosuppressed patient is challenging because of increased frequency of unusual microbes and other non-infectious mimics. However, our case illustrates that common organisms may have uncommon presentations in immunosuppressed patients.
Shanghai fever can occur in Los Angeles. A thorough physical exam and microbiological evaluation is needed for accurate diagnosis. We report the first case of Shanghai fever in an adult kidney-pancreas recipient. We want to inform the clinicians about pseudomonas enteric disease therefore, describe its diagnosis and management