HDCN Article Review/Hyperlink

Finn M, Dale B, Isles C

Beware of dog! A syndrome resembling thrombotic thrombocytopenic purpura associated with Capnocytophaga canimorsus septicemia

Nephrol Dial Transplant (Sep) 11:1839-1840 1996

A syndrome resembling TTP associated with Capnocytophaga canimorsus was first described by Scarlett et al in Am J Med, 1991 (90:127-128). For you non-Latin scholars, "canimorsus" means dogbite. In this paper, Finn et al recount the tale of an elderly woman who presented with fever, headache, and neck stiffness, purpuric rash, high fever, and hypotension. She was found to be septic with a Gram-negative bacillus that turned out to be Capnocytophaga canimorsus, an organism that has been associated with dog bites. Initial treatment was with benzylpenicillin and netilmicin. Subsequently the patient developed altered mental status, gangrenous changes of nose and toes, and renal and respiratory failure, low platelet count, and schistocytes on blood smear. She recoverd slowly after treatment with antibiotics, high dose steroids and plasma exchange. She denied being bitten by a dog, but had a dog that frequently licked her face, and the inference drawn was, that perhaps this particular bacterium, or related organisms carried in dogs' oral secretions, may cause a TTP-like illness.

Comment: One problem is that features characteristic of TTP developed somewhat late in this patient's course. Nevertheless, it suggests a possible etiology for some otherwise unexplained TTP-like illnesses. (John T. Daugirdas, M.D., University of Illinois at Chicago)