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Chest Infections |

A Rare Cause of Pneumonia and Septic Shock in an Immunocompetent Host

Ankur Girdhar, MD; Amita Singh, MD; Faisal Usman, MD; Abubakr Bajwa, MD
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UF College of Medicine at Jacksonville, Jacksonville, FL


Chest. 2013;144(4_MeetingAbstracts):200A. doi:10.1378/chest.1684235
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Abstract

SESSION TITLE: Infectious Disease Cases II

SESSION TYPE: Affiliate Case Report Slide

PRESENTED ON: Sunday, October 27, 2013 at 01:15 PM - 02:45 PM

INTRODUCTION: This case describes pneumonia in an immuno-competent patient caused by Myeroid odoratimimus. This gram-negative rod is widely distributed in the environment and generally behaves as a low-grade opportunistic pathogen in severely immuno-compromised patients.

CASE PRESENTATION: A 27-year-old male presented to hospital with progressive shortness of breath for 2 weeks associated with cough and yellowish expectoration. He had fever and a recent 10-pound weight loss. He denied chest pain or hemoptysis. He had no significant past medical history. He was an active smoker but denied illicit drug use. He was working in a fish farm. At the time of presentation, patient was tachypnic, tachycardic and hypotensive. He appeared cachetic. On auscultation of chest patient had scattered crepitations on the left side of chest with diminished breath sounds in bibasilar areas. On cardiac examination, patient was found to have S3 gallop. There was bilateral pitting edema of the legs. He had no leucocytosis. Patient was hyponatremic and had metabolic acidosis. His INR was elevated at 3.5 with decreased platelet count. CT Chest showed bilateral hazy opacification left more than right and right sided pleural effusion. Patient was admitted to ICU with a presumptive diagnosis of pneumonia with septic shock and DIC. He developed respiratory failure requiring intubation and circulatory failure requiring vasopressors. Patient’s blood gas revealed severe mixed acidosis with pH : 7.04, pCO2 : 63mmHg, pO2 : 71 mmHg and bicarbonate : 17 mEq/L. In the view of deteriorating clinical picture, broad-spectrum antibiotics were started. An echocardiogram showed ejection fraction of 15-20 % with generalized hypokinesis. Cardiac enzymes were negative with pro-BNP of 6083. EKG showed sinus tachycardia. Initial cultures including blood, urine and endotracheal aspirate were negative. When patient did not improve after three days of therapy, a bronchioalveolar lavage was done which was positive for gram-negative rods, finally identified as Myroides odoratimimus. This organism was resistant to aminoglycosides and cefepime but was susceptible to meropenem. Accordingly, antibiotics were changed to meropenem with progressive improvement in patient’s clinical status.

DISCUSSION: To our knowledge, this is first case of pneumonia and septic shock due to Myeroid odoratimimus in an immune-competent patient without any cutaneous and soft tissue involvement. This bacterium is well known to cause non-pulmonary infections such as urinary tract infections, endocarditis and cellulitis.

CONCLUSIONS: Our case highlights that this rare opportunistic pathogen, which generally affects immune-compromised hosts, can also cause life-threatening infections in an immune-competent hosts.

Reference #1: Benedetti P, Rassu M, Pavan G et al. Septic shock, pneumonia, and soft tissue infection due to Myroides odoratimimus: report of a case and review of Myroides infections. Infection 2011; 39:161-165

DISCLOSURE: The following authors have nothing to disclose: Ankur Girdhar, Amita Singh, Faisal Usman, Abubakr Bajwa

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