After Consuming Alcohol With Raw Beef, a Man Has Seizure, Pain

Aneesh Basheer, MD


December 05, 2022

Physical Examination and Workup

Upon examination, the patient is febrile (temperature, 102.2 °F [39 °C]). His heart rate is 98 beats/min and regular, blood pressure is 100/60 mm Hg, respiration rate is 26 breaths/min, and oxygen saturation is 90% while breathing room air. He is confused, and his Glasgow Coma Scale score is 6/15.

The respiratory system examination is unremarkable except for bilateral basal crackles. The abdomen is diffusely tender and distended, and shifting dullness is noted on percussion. Nasogastric aspiration reveals coffee ground aspirate. In view of his respiratory distress, the patient is admitted to the intensive care unit and mechanical ventilation is started.

Laboratory investigations reveal a hemoglobin level of 12.3 g/dL (reference range, 13.2-17.1 g/dL); a total white blood cell count of 24.2 × 109 cells/L (reference range, 4-11 × 109 cells/L), with 60% neutrophils; and a platelet count of 0.9 × 109 cells/L (reference range, 150-400 × 109 cells/L). The results of liver function tests are essentially normal, except for a prolonged prothrombin time of 16.2 sec (reference range, 11-12.5 sec). His international normalized ratio is 1.3 (reference range, 0.8-1.1). Testing for fibrin degradation products is positive. A blood smear and antigen detection tests for malaria and dengue NS1 antigen are negative. Tests for antibodies to HIV and hepatitis C virus and surface antigen of hepatitis B are negative. Arterial blood gas analysis demonstrates metabolic acidosis.

CT of the brain reveals multiple hemorrhages in the right cerebral hemisphere. Abdominal ultrasound shows hepatosplenomegaly and ascites. Abdominal paracentesis yields hemorrhagic fluid with high albumin and normal amylase levels. The serum amylase level is also normal. Blood cultured in an automated BacT/Alert system indicates growth at 6 hours. Gram staining done from the initial growth on the culture shows long gram-positive bacilli.


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