(618) Allergic to Sharing Ice Cream With Her Cat: P multocida Epiglottitis Presents as Anaphylactic Shock

Introduction: Pasteurella multocida is a small, gram-negative coccobacilli associated with dogs and cats. P. multocida infections commonly present as soft tissue infections secondary to a scratch, bite, or lick. Pneumonia is reported to be the most common respiratory manifestation. We report a case of a 64-year-old female who presented as acute anaphylactic shock. Later, her symptoms were found to be due to P. multocida causing rapidly progressive tracheobronchitis and severe septic shock. Life threatening epiglottitis and tracheal disease due to P. multocida has previously been described in the literature but it is extremely rare.

Description: A 64-year-old female with history of emphysema and polysubstance use disorder in remission on suboxone was found unresponsive with concern for anaphylaxis. Her throat and tongue were swollen and she was given epinephrine and diphenhydramine in the field. When she arrived to the emergency room, her respiratory status worsened and she became hypotensive, concerning for anaphylactic shock. She required intubation and pressor support with an epinephrine drip. The patient was admitted to the intensive care unit. She developed atrial fibrillation with rapid ventricular rate and required cardioversion with return of normal sinus rhythm. She was found to be in septic shock and P. multocida was isolated from blood and respiratory cultures. She was treated with intravenous ampicillin/sulbactam for six days and improved after four. Once P. multocida was isolated from cultures, detailed history revealed that she shared ice cream cones with she and her cat alternately licking the ice cream. Her trans-thoracic echocardiogram was negative for valvular abnormalities. Oxygen requirements were weaned and the patient was de-escalated to oral amoxicillin/clavulanate for two weeks and the patient was discharged to a rehabilitation facility.

Discussion: The extent of patient’s initial throat/tongue swelling was so severe it initially presented as concerning for acute anaphylactic shock. Upon further workup, she was severely septic secondary to rapidly progressing P. multocida tracheobronchitis with a massive inflammatory response. Notably, the patient did not have risk factors for severe disease, including cirrhosis, hematologic cancer, or history of organ transplant.