bone marrow transplantation, brevundimonas vesicularis, sepsis
B Vahid. Brevundimonas Vesicularis Bacteremia Following Allogeneic Bone Marrow Transplantation. The Internet Journal of Infectious Diseases. 2005 Volume 5 Number 1.
Bacterial infection and sepsis is a major cause of morbidity and mortality after hematopoietic stem cell transplantation. We report a case of
The patient was a 36 year-old African American woman with a two year history of acute myelogenous leukemia (AML). She was initially treated with an induction chemotherapy regimen of Idarubicin and Ara-C with only a partial response. She required a second course of chemotherapy with the same agents to achieve a complete remission. She received two additional courses of consolidation chemotherapy with high dose Ara-C after achieving full remission to maintain her in remission for 7 months. At that point a bone marrow biopsy with flow cytometry revealed evidence of recurrent disease. Autologous PBSCT was considered due to lack of an allogeneic marrow donor. Autologous PBSCT was performed following standard conditioning with Busulfan and Cytoxan. Recurrence of AML was detected 6 months after autologous PBSCT and she underwent salvage chemotherapy with Etoposide and Mitoxantrone. One month later, she was in morphological remission but the cytogenetic analysis of the bone marrow was positive. Mismatched related donor PBSCT was performed. After her pancytopenia resolved she was discharged home. She was readmitted 45 days post transplant for evaluation of fever and cough of one day duration. On examination she was in respiratory distress with a respiratory rate of 30/min, temperature of 103°F, heart rate of 120 beats/min and a blood pressure of 75/40 mm Hg. Chest auscultation revealed bilateral diffuse crackles. Cardiac, abdominal and neurological examination was unremarkable. There were no indwelling intravascular devices. Two sets of blood cultures were obtained and she was started on empiric broad spectrum antimicrobial coverage including Vancomycin, Meropenem, Amikacin, Amphotericin B and Gancyclovir. The initial chest radiograph showed bilateral diffuse bilateral air-space opacities (Figure 1a). She developed severe hypoxemic respiratory failure requiring intubation and mechanical ventilation. She required vasopressor therapy for hypotension unresponsive to fluid resuscitation. A diagnosis of Septic Shock and Acute Respiratory Distress Syndrome (ARDS) was made. Repeat chest radiograph showed progression of her bilateral parenchymal infiltrates (Figure 1b).
Unfortunately the patient died less than 24 hours after presentation. Sputum and tracheal aspirate cultures grew only normal flora. The two aerobic blood cultures grew a gram-negative rod after 5 days of incubation. The organism was oxidase positive, fermented only glucose and esculin, and produced yellow pigment on blood agar.
Bobbak Vahid, MD Thomas Jefferson University 1015 Chestnut Street, Suite M-100 Philadelphia, PA 19107 Tel: 215 955-6591 Fax: 215 955-0830 Bobbak.firstname.lastname@example.org