Nasser  Al-Rubai’aan,Rita  Dhar,Wadha A. Alfouzan,
A Rapidly Fatal Case of Lactobacillus Rhamnosus Sepsis Associated with Thyroid Storm in an Immunocompetent Patient
European Journal of General Medicine
2019
2613-5949
http://dx.doi.org/10.31487/j.EJGM.2019.01.02
https://www.sciencerepository.org/a-rapidly-fatal-case-of-lactobacillus-rhamnosus-sepsis-associated-with-thyroid-storm-in-an-immunocompetent-patient_EJGM-2019-1-102 
Abstract: We report a rapidly fatal case of 29-year-old man who presented with typical features of sepsis along with thyrotoxicosis. Presence of thrombotic lesions in his lower extremities led to the assumption that the source of infection could be endocarditis. However, transthoracic echocardiography did not confirm the preliminary diagnosis. Report of facultative anaerobic Gram-positive bacilli seen in the Gram stain of positive blood culture prompted initiation of treatment with ceftriaxone, vancomycin and metronidazole. Thyrotoxicosis was managed with propranolol, propylthiouracil, Lugol’s iodine and hydrocortisone. Diagnostic criteria for thyroid storm and infective endocarditis and therapy of Lactobacillus sepsis with a possible cause of death in the present case are discussed.Keywords: L. rhamnosus, bacteremia, thyrotoxicosis, thyroid storm, sepsis, management