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Case Reports in Gastrointestinal Medicine
Volume 2018, Article ID 5714053, 2 pages
https://doi.org/10.1155/2018/5714053
Case Report

Spontaneous Bacterial Peritonitis due to Lactobacillus paracasei in Cirrhosis

Department of Medicine, University of California, San Francisco Medical Center, San Francisco, CA, USA

Correspondence should be addressed to Emily Harding-Theobald; ude.fscu@dlaboeht-gnidrah.ylime

Received 28 November 2017; Accepted 5 February 2018; Published 1 March 2018

Academic Editor: Hideto Kawaratani

Copyright © 2018 Emily Harding-Theobald and Bharat Maraj. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Lactobacillus species colonize the human gastrointestinal tract and are rarely pathogenic. We present a case involving a cirrhotic patient who presented with sepsis and was found to have peritoneal cultures demonstrating Lactobacillus as the sole pathogen concerning for spontaneous bacterial peritonitis. Treatment was achieved with high-dose penicillin and clindamycin but the patient developed hepatorenal syndrome and died from acute renal failure. Intra-abdominal Lactobacillus infections are typically seen in patients undergoing peritoneal dialysis or who have recently had bowel perforation. There are few case reports of spontaneous Lactobacillus peritonitis in patients with cirrhosis. Our case report addresses the challenges of Lactobacillus treatment and suggests antibiotic coverage of commensal organisms in patients who do not improve with standard management.