Pseudomonas stutzeri gastrointestinal infection in a patient with cardiovascular disease: a case report

Pseudomonas stutzeri is a ubiquitous saprophyte and opportunistic pathogen capable of forming colonies and biofilms in various ecological niches, including soil and water. According to previous reports, this is a crucial virulence factor, enabling the bacterium to infect immunocompromised patients and individuals with a history of previous surgery, relapsed infective endocarditis after several years in patients with heart disease, trauma, skin infections, cardiovascular disease, or prosthetic devices. This report details an uncommon gastrointestinal infection resulting from P. stutzeri in a patient who has cardiovascular disease.

This report presents the case of a 61-year-old Iranian livestock farmer who was admitted to our hospital in the southern Fars province, Iran, with bloody diarrhea, vomiting, fever, and chills. The patient had a medical history including ischemic heart disease, hypertension, pulmonary arterial hypertension, and heart failure with reduced ejection fraction, as well as a left bundle branch block. He had undergone a coronary angiogram the previous year. During his admission and hospitalization, an increase in total white blood cell count, erythrocyte sedimentation rate, and C-reactive protein levels led to suspicion of an infection with associated inflammation. According to the bacteriology laboratory, the bloody diarrhea specimen was cultured, and the BD Phoenix ^™ M50 (Becton, Dickinson, USA) automated system confirmed the presence of an intestinal infection caused by P. stutzeri. The final diagnosis was infected gastroenteritis, and the patient was treated with a 400 mg/40 ml intravenous solution of ciprofloxacin until able to be taken orally every 12 h for 7 days and metronidazole (500 mg) IV every 8 h until able to be taken 250 mg orally every 6 h for 7 days.

Corresponding to previous case reports about the relapse of P. stutzeri in patients with heart failure, this case report shows how patients with heart failure and a history of cardiovascular disease may be at increased risk of contracting an intestinal infection of P. stutzeri from the environment.