Cellulitis due to Pseudomonas putrefaciens: possible production of exotoxins

Pseudomonas putrefaciens has been described as a rare cause of both lower-limb cellulitis and septicemic illness with significant morbidity. We report a case of P. putrefaciens infection in a patient with refractory lower-limb cellulitis and ulceration complicated by thrombocytopenia, hypotension, and mental obtundation in the apparent absence of bacteremia. This scenario raises the possibility of significant production of exotoxins by P. putrefaciens in vivo.