# Survival after cardiopulmonary arrest due to Capnocytophaga canimorsus sepsis: A case successfully managed using plasma exchange

## TL;DR

A woman survived a life-threatening infection from a dog bite using plasma exchange and intensive care, marking the first such case reported.

## Contribution

First documented survival from Capnocytophaga canimorsus sepsis-induced cardiopulmonary arrest using plasma exchange.

## Key findings

- Plasma exchange helped resolve thrombotic microangiopathy in a patient with Capnocytophaga canimorsus sepsis.
- Multidisciplinary critical care and early diagnosis led to full recovery after cardiac arrest from this infection.
- The patient achieved neurological and organ function recovery following intensive treatment.

## Abstract

•First reported survival after cardiopulmonary arrest caused by Capnocytophaga canimorsus sepsis.•Plasma exchange contributed to recovery from secondary thrombotic microangiopathy.•Early diagnosis and multidisciplinary intensive care were crucial for full recovery.

First reported survival after cardiopulmonary arrest caused by Capnocytophaga canimorsus sepsis.

Plasma exchange contributed to recovery from secondary thrombotic microangiopathy.

Early diagnosis and multidisciplinary intensive care were crucial for full recovery.

Capnocytophaga canimorsus sepsis is potentially fatal, even in immunocompetent hosts. This report describes a case involving a 57-year-old woman, who developed fever after a dog bite and initially presented without an evident focus. On the day of admission, she deteriorated to pulseless electrical activity during transport and achieved return of spontaneous circulation after approximately 23 minutes of resuscitation. Broad-spectrum antimicrobials (meropenem) were initiated for septic shock, and Capnocytophaga canimorsus subsequently grew in both the pre-admission and admission blood cultures. Peripheral discoloration suggested purpura fulminans. A precipitous decline in platelet count, schistocytosis, elevated lactate dehydrogenase levels, and acute kidney injury fulfilled the criteria for thrombotic microangiopathy, whereas ADAMTS13 activity was normal. Intensive care consisted of red blood cell and platelet transfusions, continuous hemodiafiltration transitioning to intermittent hemodialysis, mechanical ventilation with tracheostomy, and therapeutic plasma exchange once daily for three sessions. Hematological abnormalities resolved, schistocytes disappeared, organ dysfunction improved, and she was ultimately removed from ventilation and dialysis with full neurological recovery. This report describes survival after cardiopulmonary arrest due to Capnocytophaga canimorsus sepsis and suggests that plasma exchange may be a useful adjunct for secondary thrombotic microangiopathy in this setting. Early diagnosis, prompt antibiotic treatment, and multidisciplinary critical care are essential.