# Capnocytophaga canimorsus Septicemia With Sepsis-Induced Coagulopathy and Endocarditis

## TL;DR

An elderly woman developed severe sepsis and heart infection after a dog bite, highlighting the rare and dangerous effects of Capnocytophaga canimorsus.

## Contribution

This case report highlights the rare complication of endocarditis and challenges in diagnosing coagulopathy in C. canimorsus sepsis.

## Key findings

- C. canimorsus sepsis can lead to sepsis-induced coagulopathy and mitral valve endocarditis.
- Conservative antibiotic treatment successfully managed endocarditis without surgery.
- Distinguishing between coagulopathy subtypes remains challenging in early stages of infection.

## Abstract

Capnocytophaga canimorsus is a rare cause of serious infections with a high mortality of 10% to 30%. It is usually found in the oral cavity of cats and dogs and can cause severe sepsis in immunocompromised patients. An 81-year-old female Caucasian patient presented with C. canimorsus sepsis after a dog bite in her finger three days before presentation to our emergency department. She initially was presented to us with sepsis, thrombopenia, and schistocytes in her laboratory findings, suggesting the differential diagnoses of the multiple subtypes of thrombotic microangiopathy. She was admitted to the medical intensive care unit of the University Hospital of Saarland because of septic shock with circulatory insufficiency. The patient received plasmapheresis, antibiotics, and dialysis, under which she improved significantly. The fingertip of the affected finger developed necrosis and had to be amputated. Furthermore, the patient was diagnosed with a mitral valve endocarditis, a very rare complication of C. canimorsus infection. It was treated conservatively with antibiotics and was no longer detectable 8 weeks after the diagnosis. Surgical intervention was not needed. The case describes well that it is still difficult to distinguish between thrombotic thrombocytopenic purpura (TTP), disseminated intravascular coagulation (DIC), and sepsis-induced coagulopathy (SIC), especially in the early phases of acute disease, especially in C. canimorsus-induced sepsis.