# Quadruple Complication in a Patient With Liver Cirrhosis: A Diagnostic Conundrum

## TL;DR

A cirrhosis patient with diabetes faced four severe infections and complications during a single hospital stay, including a rare bacterial infection.

## Contribution

Reports a unique case of spontaneous bacterial peritonitis caused by Serratia ficaria in a cirrhosis patient.

## Key findings

- A patient with cirrhosis and diabetes developed SBP, liver abscesses, a peri-nephric abscess, and portal vein thrombosis.
- The SBP was caused by Serratia ficaria, a bacterium not previously reported in such cases.
- The case highlights diagnostic and management challenges in immunocompromised cirrhosis patients.

## Abstract

The incidence of bacterial infections is high in patients with liver cirrhosis (LC) due to compromised immune systems. They are associated with acute hepatic decompensation, multiorgan dysfunction, high morbidity, and mortality and account for 25-46% of all hospitalizations. The mortality rate is about 30% after one month and increases to 63% at one-year follow-up. While spontaneous bacterial peritonitis (SBP), urinary tract infections, soft tissue infections, and respiratory tract infections (pneumonia) are some of the common infections, SBP accounts for 25-31% of the cases and is the most frequent bacterial infection. Impaired activity of the phagocytes of the reticuloendothelial system, decreased production of the complement, and bacteria gaining access into the systemic circulation through the porto-systemic shunts are some of the causes of high-risk bacterial infection in patients with LC. The diagnosis of bacterial infection may be challenging as the typical symptoms like fever may not always be evident. We present a very challenging, middle-aged patient of cirrhosis with diabetes mellitus (DM) who presented with infections at multiple sites like SBP due to Serratia ficaria, multiple pyemic liver abscesses, left peri-nephric abscess with septicaemia, further complicated by portal vein thrombosis - all during single hospital admission. SBP was unique in the sense that no case of SBP due to Serratia ficaria has been published in the literature to date. The stormy clinical course, management, and outcome of the patient are described here.