Peripherally inserted central catheter-related bloodstream infection due to Tsukamurella pulmonis: a case report and literature review

Abstract

Background: Tsukamurella pulmonis is an aerobic gram-positive and rod-shaped organism that causes central catheter-related bloodstream infections in immunocompromised hosts. However, peripherally inserted central catheter (PICC)-related bloodstream infections due to this organism have not been reported.

Case presentation: We describe a case of a 48-year-old man with acquired immunodeficiency syndrome and diffuse large B cell lymphoma who received five courses of chemotherapy including rituximab , cyclophosphamide , doxorubicin hydrochloride , vincristine , and prednisone via a PICC. Five days after the last chemotherapy course, he presented with a high fever and shaking chills. His absolute neutrophil count was 4200/μL. Cultures obtained from blood and PICC culture revealed T. pulmonis. The colony count of T. pulmonis grown from PICC culture was 10³ colony-forming units. Therefore, he was diagnosed with T. pulmonis bacteremia resulting from PICC-related bloodstream infection. The patient's condition improved and he became afebrile within 48 h after intravenous administration of cefozopran hydrochloride, which is a fourth generation cephalosporin.

Conclusions: PICCs can be associated with T. pulmonis bacteremia, and fourth generation cephalosporins may be effective treatment.

Keywords: Acquired immunodeficiency syndrome (AIDS); Catheter-line associated bloodstream infection (CLABSI); Diffuse large B cell lymphoma (DLBCL); Peripherally inserted central catheters (PICCs); Tsukamurella pulmonis.