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Fatal hemorrhagic pneumonia caused by Stenotrophomanas maltophilia in a patient with non-Hodgkin lymphoma

Abstract

Stenotrophomonas maltophilia is increasingly emerging as a multiresistant pathogen in the hospital environment. In immunosuppressed patients, this bacterium may cause severe infections associated with sepsis and multiple organ dysfunction. We report on a 57-year-old woman treated with intensive chemotherapy for non-Hodgkin lymphoma who developed severe neutropenia, hemorrhagic pneumonia, and acute respiratory failure, which led to her death within 36 h of onset of pneumonia. Postmortem examination revealed bilateral extensive intraalveolar hemorrhage associated with severe infection by the gram-negative bacterium Stenotrophomonas maltophilia. In vitro susceptibility testing showed resistance to carbapenem, cephalosporines and aminoglycosides, but sensitivity to minocycline, ciprofloxacin, levofloxacin, and trimethoprim/sulfamethoxazole (cotrimoxazole). Early diagnosis and adequate antibiotic treatment were difficult, as the clinical course was rapid and fulminant, and this bacterium is resistant to multiple antibiotics. To improve prognosis in such cases, it will be necessary to develop an effective prophylactic strategy for high-risk patients.

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References

  1. Pagano L, Caira M, Candoni A, Offidani M, Fianchi L, Martino B, et al. The epidemiology of fungal infections in patients with hematologic malignancies: the SEIFEM-2004 study. Haematologica. 2006;91:1068–75.

    PubMed  Google Scholar 

  2. A’Court C, Garrard CS. Nosocomial pneumonia in the intensive care unit: mechanisms and significance. Thorax. 1992;47:465–73.

    PubMed  Article  Google Scholar 

  3. Denton M, Kerr KG. Microbiological and clinical aspects of infection associated with Stenotrophomonas maltophilia. Clin Microbiol Rev. 1998;11:57–80.

    PubMed  CAS  Google Scholar 

  4. Dignani MC, Grazziutti M, Anaissie E. Stenotrophomonas maltophilia infections. Semin Respir Crit Care Med. 2003;24:89–98.

    PubMed  Article  Google Scholar 

  5. Vartivarian SE, Anaissie EJ, Kiwan EN, Papadakis KA. The clinical spectrum of Stenotrophomonas (Xanthomonas) maltophilia respiratory infection. Semin Respir Crit Care Med. 2000;21:349–55.

    PubMed  Article  CAS  Google Scholar 

  6. Micozzi A, Venditti M, Monaco M, Friedrich A, Taglietti F, Santilli S, et al. Bacteremia due to Stenotrophomonas maltophilia in patients with hematologic malignancies. Clin Infect Dis. 2000;31:705–11.

    PubMed  Article  CAS  Google Scholar 

  7. Araoka H, Baba M, Yoneyama A. Risk factors for mortality among patients with Stenotrophomonas maltophilia bacteremia in Tokyo, Japan, 1996–2009. Eur J Clin Microbiol Infect Dis. 2010;29:605–8.

    PubMed  Article  CAS  Google Scholar 

  8. Elsner HA, Duhrsen U, Hollwitz B, Kaulfers PM, Hossfeld DK. Fatal pulmonary hemorrhage in patients with acute leukemia and fulminant pneumonia caused by Stenotrophomonas maltophilia. Ann Hematol. 1997;74:155–61.

    PubMed  Article  CAS  Google Scholar 

  9. Abbas AA, Fryer CJ, Felimban SK, Yousef AA, Fayea NY, Osoba O. Stenotrophomonas maltophilia infection related mortality during induction in childhood acute lymphoblastic leukemia. Med Pediatr Oncol. 2003;41:93–4.

    PubMed  Article  Google Scholar 

  10. Rousseau A, Morcos M, Amrouche L, Fois E, Casetta A, Rio B, et al. Lethal pulmonary hemorrhage caused by a fulminant Stenotrophomonas maltophilia respiratory infection in an acute myeloid leukemia patient. Leuk Lymphoma. 2004;45:1293–6.

    PubMed  Article  Google Scholar 

  11. Ortin X, Jaen-Martinez J, Rodriguez-Luaces M, Alvaro T, Font L. Fatal pulmonary hemorrhage in a patient with myelodysplastic syndrome and fulminant pneumonia caused by Stenotrophomonas maltophilia. Infection. 2007;35:201–2.

    PubMed  Article  CAS  Google Scholar 

  12. Muder RR. Optimizing therapy for Stenotrophomonas maltophilia. Semin Respir Crit Care Med. 2007;28:672–7.

    PubMed  Article  Google Scholar 

  13. Freifeld AG, Bow EJ, Sepkowitz KA, Boeckh MJ, Ito JI, Mullen CA, et al. Clinical practice guideline for the use of antimicrobial agents in neutropenic patients with cancer: 2010 update by the Infectious Diseases Society of America. Clin Infect Dis. 2011;52:e56–93.

    PubMed  Article  Google Scholar 

  14. Tamura H, Yamashita S, Kusano N, Suzuki C, Yamaguchi Y, Tanigawa K, et al. Fulminant hepatitis complicated by small intestine infection and massive hemorrhage. J Gastroenterol. 1998;33:412–8.

    PubMed  Article  CAS  Google Scholar 

  15. Ohkoshi Y, Ninomiya H, Mukai HY, Mochizuki N, Hori M, Nagasawa T, et al. Pseudoaneurysm of the subclavian artery due to Xanthomonas pneumonia in a patient with acute myeloid leukemia: its rupture treated by transcatheter coil embolization. Intern Med. 1999;38:671–4.

    PubMed  Article  CAS  Google Scholar 

  16. Windhorst S, Frank E, Georgieva DN, Genov N, Buck F, Borowski P, et al. The major extracellular protease of the nosocomial pathogen Stenotrophomonas maltophilia: characterization of the protein and molecular cloning of the gene. J Biol Chem. 2002;277:11042–9.

    PubMed  Article  CAS  Google Scholar 

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Correspondence to Naoto Takahashi.

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Takahashi, N., Yoshioka, T., Kameoka, Y. et al. Fatal hemorrhagic pneumonia caused by Stenotrophomanas maltophilia in a patient with non-Hodgkin lymphoma. J Infect Chemother 17, 858–862 (2011). https://doi.org/10.1007/s10156-011-0261-y

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  • DOI: https://doi.org/10.1007/s10156-011-0261-y

Keywords

  • Stenotrophomonas maltophilia
  • Hemorrhagic pneumonia
  • Hematological malignancy