ABSTRACT
RATIONALE: Very few cases of secondary peritonitis caused by Streptococcus pneumoniae have been described in the literature, and they have been found to occur mostly in patients with predisposing factors. Here, we report the case of an elderly patient who developed pneumococcal peritonitis secondary to perforation of gastroduodenal ulcer. PATIENT CONCERNS: An 82-year-old man was admitted to intensive care unit (ICU) for septic shock with cardiac impairment 1 day after arriving in the Emergency Department. DIAGNOSES: The patient presented with pneumococcal bacteremia and pneumococcal antigenuria. No abdominal defense was found on examination. A computed tomography scan revealed pneumoperitoneum and peritoneal effusions. INTERVENTIONS: The patient was treated with effective empiric antibiotic therapy, and delayed surgery. OUTCOMES: The patient gradually improved and was discharged from ICU on day 14. The ultimate outcome was unfavorable, with death occurring on day 28. LESSONS: This rare infection can occur in elderly patients even in the absence of other predisposing factors. Secondary peritonitis may be suspected in patients with positive pneumococcal antigenuria or unexplained pneumococcal bacteremia, especially if an asthenic form is possible.
Subject(s)
Anti-Bacterial Agents/administration & dosage , Digestive System Surgical Procedures/methods , Peptic Ulcer/complications , Peritonitis , Pneumococcal Infections , Pneumoperitoneum , Shock, Septic , Streptococcus pneumoniae/isolation & purification , Aged, 80 and over , Bacteremia/etiology , Bacteremia/microbiology , Bacteremia/therapy , Humans , Male , Peptic Ulcer Perforation/complications , Peptic Ulcer Perforation/diagnosis , Peptic Ulcer Perforation/physiopathology , Peptic Ulcer Perforation/surgery , Peritonitis/etiology , Peritonitis/microbiology , Pneumococcal Infections/diagnosis , Pneumococcal Infections/etiology , Pneumococcal Infections/therapy , Pneumoperitoneum/diagnostic imaging , Pneumoperitoneum/etiology , Shock, Septic/diagnosis , Shock, Septic/microbiology , Shock, Septic/physiopathology , Shock, Septic/therapy , Tomography, X-Ray Computed/methods , Treatment OutcomeABSTRACT
SCOPE: This study examined the interaction of fish oil (FO) with dexamethasone on glucose and lipid metabolisms in healthy subjects. METHODS AND RESULTS: The study included two consecutive parts. Part A (randomized) in 16 subjects studied the effects of dexamethasone (2 days, 2 mg/day) versus placebo (lactose), part B (two parallel subgroups of eight) studied the interaction of FO (3 wk, 840 mg/day of EPA + DHA) with dexamethasone. Insulin sensitivity of lipolysis (d5-glycerol infusion + microdialysis), endogenous glucose production, and muscle glucose uptake were assessed by a three-step hot insulin clamp and substrate oxidation by indirect calorimetry. Dexamethasone induced liver and peripheral insulin resistance, an increase in fat oxidation, and a decrease in suppression of plasma nonesterified fatty acids (NEFAs). FO amplified the effects of dexamethasone by increasing liver and muscle insulin resistance, by reducing suppression of plasma NEFAs and fat oxidation and by increasing adipose tissue (AT) lipolysis. CONCLUSION: FO, given at a moderate dose in healthy subjects prior to a very short-term (2 days) low dose of a synthetic glucocorticoid, worsened its deleterious effects on insulin sensitivity. The enhancing effect of FO on fat oxidation and AT lipolysis might be a protective effect toward an increase in fat mass.
