Sphingomonas Paucimobilis Pneumonia Complicated by Empyema in an Immunocompetent Patient: A Case Report and Concise Review of Literature

Lacrimal Drainage Infections with Sphingomonas paucimobilis: Clinical Presentations, Complications and Outcomes

PURPOSE

To report the clinical presentations, complications, and outcomes of Sphingomonas paucimobilis-specific lacrimal drainage infections.

METHODS

A retrospective chart review of all patients diagnosed with Sphingomonas paucimobilis lacrimal infections and managed at a tertiary care Dacryology Service from November 2015 to May 2022 over a 6.5-year period were recruited and analyzed. Data collected include demographic details, clinical presentation, microbiological diagnosis, antibiotic susceptibility profiles, management, complications, and outcomes. The microbiological techniques employed were aerobic and anaerobic cultures, phenotypic identification with VITEK 2^R system, polymerase chain reaction, antibiotic sensitivity profile and minimal inhibitory concentration.

RESULTS

Twelve Sphingomonas-specific lacrimal drainage infections of 11 patients were identified. Of these five were canaliculitis and seven were acute dacryocystitis. All the seven acute dacryocystitis presented in an advanced stage; five were with lacrimal abscess and two with orbital cellulitis. The antibiotic susceptibility profile of canaliculitis and acute dacryocystitis were comparable and the organism was sensitive to several classes of antibiotics. The outcomes of punctal dilatation and nonincisional curettage were effective for canaliculitis. Patients with acute dacryocystitis had advanced clinical stage at presentation but responded well to intensive systemic management and had excellent anatomical and functional outcomes with dacryocystorhinostomy.

CONCLUSION

Sphingomonas-specific lacrimal sac infections can have aggressive clinical presentations and need early and intensive therapy. The outcomes are excellent with multimodal management.

Sphingomonas paucimobilis Septic Shock in an Immunocompetent Patient

Sphingomonas paucimobilis usually exhibits low virulence likely secondary to its lack of lipopolysaccharide A. Infections caused by S.paucimobilis more commonly afflict immunocompromised patients. Some case reports document pneumonia, osteomyelitis, pyomyoma, and septic arthritis secondary to S. paucimobilis in immunocompetent patients.

S. paucimobilis bacteremia is associated with underlying conditions, including malignancy, diabetes mellitus, end-stage renal disease, and chronic obstructive pulmonary disease. Bacteremia has the potential to lead to septic shock. Antimicrobial effectiveness varies, and the mechanism that leads to resistance has not yet been elucidated. This underscores the importance of antimicrobial susceptibility testing.

We present a unique case of community-acquired S. paucimobilis bacteremia and resultant septic shock in an immunocompetent patient. A 90-year-old female with a history of chronic kidney disease, acute colonic infarction status post colostomy, gastroesophageal reflux disease, hypertension, supraventricular tachycardia, and schizoaffective disorder presented to the emergency department with hypotension and altered mental status. Urinalysis and chest X-ray were unremarkable. Antibiotic therapy with cefepime was initiated following gram stain, which showed gram-negative rods. The blood culture revealed S.paucimobilis. The patient was discharged with the plan to enter hospice care.