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Hospital Course.
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A man in his 60s with decompensated alcoholic cirrhosis, prior episodes of upper GI hemorrhage, ascites, and hepatic encephalopathy presented to a community hospital with altered mental status and upper GI bleeding (Fig. 1).
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Abdominopelvic CT scan on hospital day 13 revealing a large complex ventral abdominal hernia (A) containing multiple loops of distal small bowel. The indistinctness of the bowel wall with pneumatosis and adjacent free air are concerning for ischemic bowel with perforation.
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A CT scan of the abdomen performed on HD 13 demonstrated ischemic and perforated bowel within the hernia (Fig. 2).
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Peritoneal fluid gram stain on HD 13 showing budding yeast, later identified as Hyphopichia burtonii. The sample was incubated on Sheep Blood Agar, and Hyphopichia burtonii was identified from a BD Phoenix (not pictured). Fig. 4. Proposed pathophysiological mechanism of Spontaneous Bacterial Peritonitis (SBP) in patients with cirrhosis.
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The ascitic culture from HD 13 was finalized post-mortem as mixed intestinal microbiota with heavy Hyphopichia burtonii (Fig. 3).