A “Kelp-Like” Microorganism Within the Belly

A 50-year-old woman suffering from paranoid schizophrenia with carelessness symptom was referred on day 0 for peritonitis caused by a perforated gastro-duodenal ulcer. In her recent medical history, anorexia, constipation, and impairment of general health condition were reported. A biological inflammatory syndrome was noticed at admission, with C-reactive protein of 320.1 mg/L, procalcitonin of 216.68 µg/L, and polymorphonuclear neutrophil count of 16.4 × 10⁹/L. To note, blood calcium, total serum protein, and hemoglobin were low at 1.77 mmol/L, 40 g/L (including 16 g/L for albumin), and 81 g/L, respectively. Several intraperitoneal abscesses were detected by computed tomography on day 3 (Figure 1). Abscess aspirate showed a moderately inflammatory liquid with no malignant cells (day 4). On the third day following the sampling (day 7), flat colonies started growing in vitro at 30°C on Sabouraud dextrose agar (BD Sabouraud Glucose Agar, Becton-Dickinson, Pont-Le-Claix, France) (Figure 2). Broad-spectrum antibiotic therapy (initially based on intravenous ceftriaxone, metronidazole, and fluconazole; amoxicillin and erythromycin were added on day 4 and on day 9, respectively) was inefficient. Noteworthy, on day 18, measurement of (1,3)-β-D-glucan antigen was positive at 474 ng/mL in serum. All blood cultures remained sterile.