Acute Fatal Peritonitis: A New Organism for Consideration

Abstract

A 40-year-old man died suddenly and unexpectedly at home. His comorbid conditions included central diabetes insipidus, obesity, and hypertension. Autopsy revealed acute and chronic pancreatitis with an abscess and associated purulent peritonitis. Peritoneal fluid cultures grew Raoultella planticola and a light growth of Candida albicans. The organism isolated, R. planticola, is a waterborne bacterium with limited previous clinical isolates causing morbidity but no previously described mortality. Vitreous humor analysis demonstrated concomitant acute water intoxication complicating the decedent's diabetes insipidus. Discussion includes a review of the literature with a description of the eight previous cases of human infection with R. planticola, a recently described organism that was previously in the genus Klebsiella. The proposed fatal pathogenesis includes retrograde entry of the organism from the gastrointestinal tract via the pancreatic duct to the pancreas and subsequent peritonitis. This is the first reported fatality caused by this organism.