S2776 A Rare Case of Pseudomonas Aeruginosa Colitis and Subsequent Bacteremia in the Setting of Alcohol-Induced Cirrhosis

Introduction: Pseudomonas aeruginosa is an opportunistic bacterium that commonly causes pneumonia and urinary tract infections. While cases of P. aeruginosa colitis have been infrequently reported, we identify a unique case of P. aeruginosa bacteremia occurring after antibiotic-treated P. aeruginosa colitis in a patient with alcohol-induced cirrhosis. Case Description/Methods: A 38-year-old male with class III obesity and alcohol use disorder presented with cramping abdominal pain, vomiting and dark stool. There was no recent hospitalization and no antibiotic or intravenous drug use. Last alcoholic drink was reported to be several days prior to presentation. Physical exam identified scleral icterus, abdominal distension without tenderness, and hepatomegaly. Laboratory test results are outlined in Table 1. Serum acetaminophen and alcohol levels were not detected. Urinalysis and chest x-ray were unremarkable. Ultrasound demonstrated cirrhotic liver morphology and ascites, but no cholelithiasis. Ceftriaxone was started due to concerns for an upper gastrointestinal bleed. On day 2, he developed watery diarrhea. Stool cultures were positive for P. aeruginosa, prompting antibiotic transition to cefepime. Clostridioides difficile testing was negative. He completed a five-day course of cefepime with resolution of diarrhea and leukocytosis. Subsequently, he was started on methylprednisolone for treatment of alcoholic hepatitis, and later discharged on a tapering dose. Eleven days later, he returned with vomiting and generalized weakness, and was admitted to the intensive care unit with pansusceptible P. aeruginosa bacteremia and septic shock. Unfortunately, clinical condition continued to deteriorate despite maximal medical therapy, and he ultimately expired. Discussion: P. aeruginosa has rarely been described in association with colitis. To our knowledge, this is the first reported case of P. aeruginosa colitis in a patient with alcohol-induced cirrhosis, and the first case of P. aeruginosa bacteremia after previously treated colitis. While the optimal duration of treatment for P. aeruginosa colitis is not well defined, this case supports extended antibiotic courses for the treatment of P. aeruginosa infections in decompensated cirrhosis and cautious post-treatment steroid utilization.Table 1.: This table depicts initial admission laboratory testing results for the patient’s two separate admissions.