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Background: In April 2024, our hospital confirmed a rare case of intra-abdominal infection by Kodamaea ohmeri. The patient sought medical attention at our hospital after taking painkillers orally for one month, experiencing recurrent abdominal pain for 17 days and worsening for 7 days. In March 2024, the patient received symptomatic treatment with oral analgesics (diclofenac sodium) for arthritis. After 2 weeks of medication, the patient experi-enced upper abdominal colic without any additional triggers. After 3 weeks of medication, the abdominal pain sig-nificantly worsened compared to before, and the pain was persistent. The patient continued to receive oral painkillers for treatment, but there was no significant improvement in symptoms. The patient went to another hospital for treatment with anti-inflammatory infusion (specific details unknown), but the effect was not satisfactory. In order to seek additional treatment, he is now seeking medical attention at our hospital.
Methods: Clinical implementation includes abdominal CT, exploratory laparotomy, repair of duodenal perforation, intestinal adhesiolysis, abdominal lavage, and pus drainage. The extracted pus was subjected to culture and identification, fungal fluorescence staining, acid fast staining, and Gram staining. Further related auxiliary examinations include blood routine, urine routine, liver function, kidney function, quantitative detection of myocardial injury, and B-type natriuretic peptide.
Results: Abdominal CT: Bilateral pleural effusion, free gas under the diaphragm and abdominal cavity, considering: 1. Gastrointestinal ulcer bleeding with perforation, 2. Acute peritonitis. Blood routine + CRP (venous blood): White blood cells 11.93 x 109/L, lymphocyte percentage 8.4%, neutrophil percentage 86.1%, whole blood high-sensitivity C-reactive protein 64.04 mg/L. Inflammatory markers: procalcitonin 55.890 ng/mL, interleukin-6 > 5,000.00 pg/mL. Myoglobin 261.6 µg/L, high-sensitivity troponin T 0.197 µg/L, B-type natriuretic peptide test (BNP): 67.06 pg/mL, liver function test: total protein 34.8 g/L, albumin 22.6 g/L, globulin 12.2 g/L, total bilirubin 27.0 µmol/L, direct bilirubin 17.9 µmol/L, aspartate aminotransferase 127.5 U/L, alanine aminotransferase 232.0 U/L, renal function test: urea 12.94 mmol/L, creatinine 175.30 µmol/L, D-dimer test 6452.47 FEU µg/L. Pus culture and identification (MALDI-TOF MS): Kodamaea ohmeri, fungal fluorescence staining: positive. Clinical treatment plan: fluconazole 0.2 g ivgtt qd, imipenem cilastatin 1 g ivgtt qd, esomeprazole 0.04 g ivgtt qd. Adjuvant therapy: fasting water, ventilator-assisted breathing, gastrointestinal decompression, acid suppression and stomach protection, analgesia and sedation, and fluid replacement. After 14 days of treatment, the patient's abdominal pain was significantly alleviated, inflammation indicators significantly decreased, and no further special discomfort was reported. The patient improved and was discharged.
Conclusions: This article reports a rare case of intraperitoneal infection by Kodamaea ohmeri. Kodamaea ohmeri was quickly and accurately identified by MALDI-TOF MS, and reasonable treatment measures were adopted clinically. The patient improved and was discharged. I hope that in the future, this study can provide assistance for the clinical diagnosis and treatment of Kodamaea ohmeri infection.
DOI: 10.7754/Clin.Lab.2024.240721
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