Did You Ask About Pets?

A 60 year old man presents with fever, disseminated purpura, hypotension, acute kidney injury, and altered mental status. He is admitted to the intensive care unit, started on broad spectrum antibiotics, and fluid resuscitated. Dermatology is worried that the lesions are becoming purpura fulminans. In the intensive care unit, he has disseminated intravascular coagulation and multiorgan failure. Past medical history is significant for chronic alcoholism. Past surgical history is significant for a splenectomy done for a trauma.

Gram stain is shown below:

This slow growing carbon loving facultative anaerobe takes several days to grow in culture. It is resistant to aztreonam.

Challenge: In the history, you find the patient was bit by...what?

Image shown under Fair Use.