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Capnocytophaga canimorsus sepsis following BMT in a patient with AML: possible association with functional asplenia

Bone Marrow Transplantation volume 49, pages 153–154 (2014)Cite this article

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Patients with functional asplenia following hematopoietic cell transplantation (HCT) or those with previous splenectomy are at risk of infections due to the absence of the spleen.1 These include infections caused by encapsulated bacteria, and in certain geographic areas by intraerythrocytic parasites. Capnocytophaga canimorsus is a fastidious, Gram-negative rod that forms part of the normal oral flora of dogs and cats. Known for its ability to cause fulminant sepsis following dog bites, particularly in asplenic patients or alcoholics,2 infection by this bacterium is uncommon after HCT. Here we report a case with development of Capnocytophaga septicemia following HCT for AML.

A 53-year-old woman was admitted to the intensive care unit after sudden onset of fever, chills, and severe rigor. She had undergone allogeneic BMT from a mismatched unrelated donor 7 years earlier for AML. She had extensive chronic GVHD but had received no immunosuppressive drugs or corticosteroid. Emergency room findings confirmed shock with tachycardia, tachypnea, and hypotension. The results of physical examination were almost normal except for hand injury due to chronic GVHD. The Hb level was 102 g/L, with a white-cell count of 8200/mm3 and a platelet count of 43 000/mm3, and her C-reactive protein level was 77 000 μg/L. The results of other blood tests and urinalysis were normal. Computed tomography (CT) of the chest, abdomen and pelvis showed normal results except for marked splenic atrophy. She was suspected of having septic shock and was managed accordingly with supportive measures, such as vasopressor and supplemental oxygen. Blood cultures were collected, and empirical treatment with meropenem (1 g three times daily) and vancomycin (1 g twice daily) was initiated. On the following day, the patient became afebrile and did not require vasopressor and supplemental oxygen. She recovered from septic shock. After 2 days, Gram-negative rods were detected in the blood cultures. Five days later, final blood culture results confirmed the presence of C. canimorsus. Treatment was changed to ceftriaxone (1 g once daily). Subsequent questioning revealed that her pet dogs had licked her wounded hands 2 days before admission. A diagnosis of C. canimorsus septicemia, transmitted by her pet dog, was made. She recovered completely and was discharged without disability 2 days later, and she remained well at a follow-up visit.

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  1. T Ugai

    Present address: Division of Hematology, Department of Medicine, Saitama Medical Center, Jichi Medical University, Saitama, Japan,

Authors and Affiliations

  1. 1Division of Hematology/Oncology, Department of Medicine, Kameda Medical Center, Chiba, Japan

    T Ugai, H Sugihara, Y Nishida, M Yamakura, M Takeuchi & K Matsue

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  1. T Ugai
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  2. H Sugihara
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  3. Y Nishida
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Correspondence to T Ugai.

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Ugai, T., Sugihara, H., Nishida, Y. et al. Capnocytophaga canimorsus sepsis following BMT in a patient with AML: possible association with functional asplenia. Bone Marrow Transplant 49, 153–154 (2014). https://doi.org/10.1038/bmt.2013.126

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