Fatal septic shock and Waterhouse-Friderichsen syndrome caused by serovar B Capnocytophaga canimorsus in an immunocompetent patient. Case report and review.

Rev Esp Quimioter 2023;36(1): 92-96 92 Two sets of blood cultures were obtained before starting empiric broad-spectrum antibiotic therapy with intravenous piperacillin-tazobactam, meropenem and clindamycin (4/0,5g single dose, 2 g/8 h and 900 mg/8 h, respectively). Despite high-dose intravenous fluid replacement, noradrenaline and bicarbonate infusions, the patient didn ́t improve and was transferred to intensive care unit after orotracheal intubation. A body CT scan was conducted, which described signs of hypovolemic shock with thickening of both adrenal glands with crosslinking of the peri-renal fluid, as well as liver with periportal edema and no highlight of the spleen (Figure 2A). Her condition deteriorated rapidly overnight and, in spite of cardiopulmonary resuscitation measures, patient expired 16 hours after admission. Because of multi-organ failure and septic shock of unknown origin, an autopsy was requested.