Bacteremic pneumonia caused by Enterococcus hirae in a subject receiving regorafenib

Infections due to Enterococcus hirae have rarely been reported in humans but are not uncommon in mammals and birds. We describe a case of E. hirae bacteremia and pneumonia in a bird breeder and its potential relationship with regorafenib, a tirosin kinase inhibitor (TKI).

Descriptive study and review of the literature through a PubMed search of the cases described previously to date.

Only seventeen cases have been described, mainly endocarditis, pyelonephritis, and intraabdominal infections. No cases of pneumonia have been reported so far. The recent increase in TKI use opens a new field to explore in infectious diseases due to both the exposure to these immunosuppressive drugs and the increased survival of subjects with severe underlying comorbidities.

In patients in contact with birds, immunosuppressed by their underlying morbidities and treated with regorafenib, clinicians should be aware of an increased risk of unusual potentially severe infections.