Spontaneous Bacterial Peritonitis due toLactobacillus paracaseiin Cirrhosis

Lactobacillusspecies colonize the human gastrointestinal tract and are rarely pathogenic. We present a case involving a cirrhotic patient who presented with sepsis and was found to have peritoneal cultures demonstratingLactobacillusas the sole pathogen concerning for spontaneous bacterial peritonitis. Treatment was achieved with high-dose penicillin and clindamycin but the patient developed hepatorenal syndrome and died from acute renal failure. Intra-abdominalLactobacillusinfections are typically seen in patients undergoing peritoneal dialysis or who have recently had bowel perforation. There are few case reports of spontaneousLactobacillusperitonitis in patients with cirrhosis. Our case report addresses the challenges ofLactobacillustreatment and suggests antibiotic coverage of commensal organisms in patients who do not improve with standard management.