#00066233

A 63-year-old with history of colorectal cancer previously treated with immunotherapy, presented with confusion, vomiting and diarrhoea. Observations revealed fever, hypoxia and tachycardia. Laboratory investigations showed hemoglobin 130 g/L, white cell count 3.1 × 10⁹/L, neutrophil count 2.6 × 10⁹/L, and platelet count 20 × 10⁹/L. The activated partial thromboplastin time and prothrombin time were prolonged, along with a depressed fibrinogen level, in keeping with DIC. Blood film showed neutrophils with marked toxic vacuolation and abundance of both intracellular and extracellular fusiform bacteria, suggestive of gram negative bacteraemia. Later, blood culture revealed Capnocytophaga canimorsus bacteraemia. Identifying bacteria on a blood smear is a rare, but can assist in expediting diagnosis in fulminant septicaemia before blood cultures become positive.