Man prescribed probiotic while recovering from COVID, doctors say. It killed him
A man in his 70s arrived at a Japanese hospital after he was found on the floor of his home. He was in and out of consciousness, and there was a crackling sound in his left lung.
During a CT scan of his chest, he went into cardiac arrest, and after a round of CPR, his heart beat again.
The man was diagnosed with severe COVID-19, confirmed with nasal swab, and was admitted to the intensive care unit, according to an Aug. 3 case report from the journal BMJ Case Reports.
The man would spend the next few weeks recovering from the virus. Then, something else killed him.
The case
After his episode during the CT scan, the man was intubated, meaning a tube was placed into his trachea that allowed air to flow to his lungs when he was unable to breathe on his own, according to the report.
He had a history of colon cancer in the past, and as a smoker and alcoholic, he had experienced chest pain and high blood pressure before, doctors said.
In the hospital, he was immediately prescribed and administered heparin, a drug to stop blood from clotting to prevent heart attacks, and dexamethasone, an anti-inflammatory.
He underwent treatment for COVID-19, fighting a bacterial infection in his lungs. But as his heart grew stronger, his lungs continued to struggle, according to the report.
Eventually, he grew strong enough to move to the general ward of the hospital and out of the ICU where he had been for 33 days, and doctors said they prescribed a probiotic to help with some digestive distress he was experiencing following treatment.
He continued to recover for the next 25 days, but on day 58 of his time in the hospital, he took a turn for the worse.
The man started to feel some pressure in his abdomen, doctors said, and he was getting tired again.
By the next day, the pain in his abdomen was severe and it was swollen and tender, according to the report. His kidneys began to fail, and blood wasn’t reaching his small and large intestine.
“The patient rapidly developed multiorgan failure, but emergent surgery was not pursued due to the extent of the ischaemia (restricted blood flow) and unstable clinical conditions,” doctors said.
On his 60th day in the hospital, just two days after his abdominal pain started, the man died.
The cause
Despite battling a severe case of COVID-19, the respiratory virus was not to blame for this man’s rapid and deadly downturn, according to the report.
Blood tests taken at the time of his organ failure found a significant Clostridium butyricum bacterial infection — from his probiotic, doctors said.
“Probiotics have been used for over a hundred years,” doctors said. “... Probiotics have been widely used in (a) variety of gastrointestinal diseases, and there are multiple reports of their effectiveness in controlling acute infectious diarrhea.”
Doctors prescribed C. butyricum to the patient to help with his intestinal distress, and the probiotic is commonly used in Japan, they said.
But what went unaccounted for was how hard his immune system was fighting off COVID-19, leaving his intestines unprotected, doctors said.
Probiotics are given as a way to reintroduce “good” bacteria into the body, something that helps regulate your gastrointestinal tract, according to the Cleveland Clinic. The “good” bacteria helps keep the “bad” bacteria at bay, which usually happens on your own inside the body.
When you take something that kills bacteria, like an antibiotic, it’s common for doctors to prescribe a probiotic to restore balance to your internal biome.
Probiotics are generally safe, doctors said, but when prescribed to severely immunocompromised patients, there is a history of adverse events, including bacteraemia.
Bacteraemia means that bacteria from part of the body, good or bad, enters the bloodstream and then is able to spread to the rest of your body where it might not be safe, according to the National Institutes of Health.
The bacteria from the patient’s probiotic was able to enter the bloodstream as his body’s defenses were fighting elsewhere, occurring at the same time as his organ failure and causing a quick death, according to the report.
The doctors acknowledge that while the bacteraemia and multiorgan failure occurred at the same time, they cannot definitively say one caused the other, and more testing would have been necessary.
This is the first reported case of “probiotics-related C. butyricum bacteraemia after treatment of severe COVID-19,” doctors said.
“While probiotics are routinely prescribed among ill patients with various gastrointestinal symptoms and conditions, rare yet severe adverse events may occur, as exemplified in this report,” the case report said.
This story was originally published August 14, 2024 at 11:49 AM with the headline "Man prescribed probiotic while recovering from COVID, doctors say. It killed him."
