Sphingomonas paucimobilis presenting as acute phlebitis: A case report

Area of Science:

• Medical Microbiology
• Infectious Diseases
• Clinical Case Reports

Background:

• Sphingomonas paucimobilis is a Gram-negative bacillus, typically found in natural environments and considered an opportunistic pathogen.
• Infections caused by Sphingomonas are rarely reported in clinical settings.
• Intravenous drug use presents unique risks for bloodstream infections.

Purpose of the Study:

• To report the first case of Acute Sphingomonas phlebitis secondary to intravenous drug use.
• To discuss the potential source of infection and treatment outcomes.
• To raise awareness about Sphingomonas paucimobilis as a potential emerging pathogen.

Main Methods:

• Case presentation of a 39-year-old male with symptoms of upper extremity infection.
• Clinical examination revealing erythema, tenderness, and venous streaking.
• Diagnostic workup including imaging (X-ray, ultrasound, MRI) and blood cultures.
• Treatment with antibiotics including vancomycin, piperacillin/tazobactam, and levofloxacin.

Main Results:

• Blood cultures confirmed Sphingomonas paucimobilis bacteremia.
• Imaging studies ruled out osteomyelitis, deep venous thrombosis, abscess, cellulitis, and pyomyositis.
• The patient was treated with a 14-day course of levofloxacin.
• Toilet water used for heroin preparation was suspected as the source of infection.

Conclusions:

• Sphingomonas paucimobilis can cause severe infections like Acute Sphingomonas phlebitis, particularly in immunocompromised individuals or those engaging in high-risk behaviors.
• The ubiquitous nature and stress resilience of Sphingomonas paucimobilis, coupled with rising antimicrobial resistance, pose a potential future threat.
• Further research is needed on early identification, pathogenesis, treatment, and eradication strategies for Sphingomonas infections.