DOI: 10.36347/sjmcr.2015.v03i08.042

Pages: 785-788

A 73-year-old female was hit in the face by a mirror from a passing car and she fell into a rice paddy field. Because she was unconscious, she was transferred to our department. After securing the airway, a traumatic pan-scan revealed a subarachnoid hemorrhage, fractures on the left side of the patient’s face, a left radical fracture and aspiration. Her face was initially deterged with massive fluid. Within a few hours from arrival, her oxygenation deteriorated rapidly. She underwent empiric therapy. The blood and sputum cultures were found to be positive for C. violaceum. The β-D glucan level became positive, thus antifungal therapy was added. After achieving an improvement inthe patient’s bloody inflammatory reaction and respiratory function, she began to complain of headache. An enhanced MRI of the patient’s head demonstrated multiple ring-enhanced areas in the brain, suggestive of a cerebral access. A spinal tap demonstrated increase of white blood cells. Meropenem, vancomycin, and fluconazole infusion therapy was administered for three months. After becoming a febrile and obtaining a negative bloody inflammatory reaction, the infusion of these antibiotics was terminated. However, the patient again developed a high fever and multiple patchy lesions in the lung and brain still remained. Her infection could not be completely controlled and she was transported to another medical facility for rehabilitation. The infusion of the maximum dose of antibiotics that can be tolerated based on the pharmacokinetics/pharmacodynamics theory must be administered when a patient is exposed to contaminated soil or water.