SESSION TITLE: Infectious Disease Cases I
SESSION TYPE: Affiliate Case Report Slide
PRESENTED ON: Sunday, October 26, 2014 at 10:45 AM - 12:00 PM
INTRODUCTION: Serratia marcescens has been implicated in various nosocomial infections. Community acquired infections are on the rise, mainly in immunocompromised hosts. Serratia skin and soft tissue infections (SSTI) are unusual and associated with an obvious site of ingress, such as a catheter. We present an unusual case of complicated SSTI arising de novo in an immunocompetent patient.
CASE PRESENTATION: A 75-year-old man with prostate cancer was seen for left lower extremity (LLE) edema. Ultrasound revealed a LLE thrombus; enoxaparin was started. In 48h, he presented with LLE erythema, bullae and pain, rapid atrial fibrillation (AF) and hypotension. He was resuscitated, started on vancomycin and admitted. Within 24h, he had recurrent hypotension. Piperacillin/tazobactam was added as blood cultures grew gram negative rods. He was admitted to the ICU with progressive bullae and erythema, hypoglycemia (20mg/dl), metabolic acidosis (pH 7.19) and coagulopathy (INR 3.35). LLE CT scan showed edema with subcutaneous nodules. Given his rapid deterioration, he underwent a LLE amputation. Blood and wound cultures grew Serratia marcescens. Pathology showed necrosis and inflammation of the soft tissues of the LLE. The patient’s post-operative course was lengthy and complicated with multiple hospital and ICU admissions, recurrent infections and ventilator dependence.
DISCUSSION: Community acuqired Serratia infections now represent almost 50% of cases, usually in immunocompromised hosts. Virulence is related to a cytotoxic pore-forming toxin (ShlAB). Case reports of severe SSTI due to S. marcescens arising de novo in immunocompetent patients are rare. Treatment relies on early appropriate antibiotics and surgical intervention. Serratia has an intrinsic resistance to linezolid and several B-lactam antibiotics. Unfortunately, even with prompt surgical intervention, morbidity can be quite severe, as in our case.
CONCLUSIONS: Complicated SSTI with Serratia marcescens may arise de novo in an immunocompetent host and can be associated with significant morbidity.
Reference #1: Vano-Galvan, S., et al., Fulminant necrotizing fasciitis caused by Serratia marcescens in an immunosuppressed host. Int J Dermatol, 2014. 53(1): p. e57-8.
Reference #2: Mahlen, S.D., Serratia infections: from military experiments to current practice. Clin Microbiol Rev, 2011. 24(4): p. 755-91.
Reference #3: Liangpunsakul, S., Community-acquired necrotizing fasciitis caused by Serratia marcescens: case report and review. Eur J Clin Microbiol Infect Dis, 2001. 20(7): p. 509-10.
DISCLOSURE: The following authors have nothing to disclose: Shiyin Zhu, Anil Singh, Nina Raoof, Stephen Pastores, Neil Halpern
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