PHOTO QUIZ
crossm Photo Quiz: Fatal Septicemia in an Immunocompromised Patient Infectious Diseases, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USAa; Department of Pathology Anatomy and Cell Biology, Clinical Microbiology, Thomas Jefferson University, Philadelphia, Pennsylvania, USAb; Department of Infectious Diseases, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania, USAc
KEYWORDS lymphoma, febrile neutropenia
Citation Nambiar PH, Tokarczyk M, DeSimone JA, Jr. 2017. Photo Quiz: Fatal septicemia in an immunocompromised patient. J Clin Microbiol 55:2877. https://doi.org/10.1128/JCM.02485-15. Editor P. Bourbeau Copyright © 2017 American Society for Microbiology. All Rights Reserved. Address correspondence to Puja H. Nambiar, [email protected]. For answer and discussion, see page 3149 in this issue (https://doi.org/10.1128/JCM.02488-15).
FIG 1 Gram stain of blood culture (original magnification, ⫻1,000).
A
65-year-old man was diagnosed with diffuse large B-cell lymphoma in 2012 and underwent systemic and intrathecal chemotherapy in 2013, followed by salvage chemotherapy and radiotherapy in 2014 for recurrence of disease. In 2015, he had cyclophosphamide priming for stem cell mobilization via a left internal jugular plasmapheresis catheter. Shortly thereafter, he was hospitalized for febrile neutropenia. Laboratory test results revealed an absolute neutrophil count of 0 cells/mm3. Enterococcus faecium was isolated from the BD Bactec Lytic/10 Anaerobic/F culture bottle (Becton Dickinson and Company) from one set of blood culture obtained at the time of hospitalization. The patient was started on intravenous vancomycin, and the plasmapheresis catheter, which was the suspected source of bacteremia, was removed on hospital day 1. Repeat sets of blood cultures performed on hospital days 2 and 3 showed no growth. Additional sets of blood cultures were drawn on hospital day 4 for persistent fever and clinical presentation of sepsis. On hospital day 6, the patient acutely decompensated and developed fatal septic shock. The BD Bactec Plus Aerobic/F bottles from two sets of blood cultures drawn on hospital day 4 were positive after 48 h of incubation and after the patient expired. These blood cultures were subcultured to appropriate media, and Gram staining was performed. The Gram stain of the organism seen in routine blood culture is shown in Fig. 1.
October 2017 Volume 55 Issue 10
Journal of Clinical Microbiology
jcm.asm.org 2877
Downloaded from http://jcm.asm.org/ on September 25, 2017 by FUDAN UNIVERSITY
Puja H. Nambiar,a Mindy Tokarczyk,b Joseph A. DeSimone, Jr.c
crossm Photo Quiz: Fatal Septicemia in an Immunocompromised Patient Infectious Diseases, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USAa; Department of Pathology Anatomy and Cell Biology, Clinical Microbiology, Thomas Jefferson University, Philadelphia, Pennsylvania, USAb; Department of Infectious Diseases, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania, USAc
KEYWORDS lymphoma, febrile neutropenia
Citation Nambiar PH, Tokarczyk M, DeSimone JA, Jr. 2017. Photo Quiz: Fatal septicemia in an immunocompromised patient. J Clin Microbiol 55:2877. https://doi.org/10.1128/JCM.02485-15. Editor P. Bourbeau Copyright © 2017 American Society for Microbiology. All Rights Reserved. Address correspondence to Puja H. Nambiar, [email protected]. For answer and discussion, see page 3149 in this issue (https://doi.org/10.1128/JCM.02488-15).
FIG 1 Gram stain of blood culture (original magnification, ⫻1,000).
A
65-year-old man was diagnosed with diffuse large B-cell lymphoma in 2012 and underwent systemic and intrathecal chemotherapy in 2013, followed by salvage chemotherapy and radiotherapy in 2014 for recurrence of disease. In 2015, he had cyclophosphamide priming for stem cell mobilization via a left internal jugular plasmapheresis catheter. Shortly thereafter, he was hospitalized for febrile neutropenia. Laboratory test results revealed an absolute neutrophil count of 0 cells/mm3. Enterococcus faecium was isolated from the BD Bactec Lytic/10 Anaerobic/F culture bottle (Becton Dickinson and Company) from one set of blood culture obtained at the time of hospitalization. The patient was started on intravenous vancomycin, and the plasmapheresis catheter, which was the suspected source of bacteremia, was removed on hospital day 1. Repeat sets of blood cultures performed on hospital days 2 and 3 showed no growth. Additional sets of blood cultures were drawn on hospital day 4 for persistent fever and clinical presentation of sepsis. On hospital day 6, the patient acutely decompensated and developed fatal septic shock. The BD Bactec Plus Aerobic/F bottles from two sets of blood cultures drawn on hospital day 4 were positive after 48 h of incubation and after the patient expired. These blood cultures were subcultured to appropriate media, and Gram staining was performed. The Gram stain of the organism seen in routine blood culture is shown in Fig. 1.
October 2017 Volume 55 Issue 10
Journal of Clinical Microbiology
jcm.asm.org 2877
Downloaded from http://jcm.asm.org/ on September 25, 2017 by FUDAN UNIVERSITY
Puja H. Nambiar,a Mindy Tokarczyk,b Joseph A. DeSimone, Jr.c
