Three Strikes

Abstract A 56-year-old female patient presented with severe abdominal pain and intra-abdominal/retroperitoneal fluid collections growing Escherichia coli and vancomycin-resistant Enterococcus faecium ; oral linezolid and cefdinir were prescibed. Pancreatic enzymes, lactate, serum chemistry studies, and blood glucose were unremarkable during initial hospitalization. The patient remained afebrile and leukocytosis resolved with antibiotics. On day 37 of linezolid therapy, serum glucose was 56 mg/dL and serum bicarbonate was 17 mEq/L (normal 23–30 mEq/L). As the patient was asymptomatic, infectious disease consultants recommended cessation of antibiotics, but they were unfortunately continued on transfer to a rehabilitation facility. On day 41 of treatment, the patient became lethargic, with serial serum glucose levels 33–34 mg/dL. Serum bicarbonate was 6 mEq/L, lactate was >15 mmol/L, and blood pressure was 80/36 mm Hg. Admission blood cultures were negative. Supportive care was instituted, but the patient continued to clinically deteriorate. Computed tomography scan of the abdomen showed hepatic steatosis and no residual fluid collections or pancreatic abnormalities. The patient expired on the third day of hospitalization.