Sphingomonas paucimobilis is a nonfermentative gram-negative bacillus of low pathogenicity. The organism has been involved in causing a wide range of infections in community and hospital settings. Only 3 cases of meningitis caused by this organism have been reported so far. We report a rare case of S paucimobilis meningitis who presented with atypical symptoms. A 50-year-old female presented with headache, dizziness, chills, shakiness, and neck pain along with nuchal rigidity. On physical examination, severe neck rigidity along with decreased range of motion was noticed. Her cerebrospinal fluid showed gram-negative rods, and she was started on meropenem. The cerebrospinal fluid grew S paucimobilis sensitive to meropenem. She subsequently showed significant improvement and was discharged home on intravenous meropenem for 21 days and showed complete recovering in 5 weeks.
A 65-year-old woman presented to our rheumatology clinic with pain and swelling of multiple joints of her hands. After a thorough evaluation, she was diagnosed with rheumatoid arthritis and was started on hydroxychloroquine therapy. A week later, she presented to our clinic with an acute condition and reported that after taking hydroxychloroquine for a few days she developed multiple rashes, most prominent at skin folds around her breasts, neck, axillae and buttocks. The rashes were characteristic of inverse psoriasis. Hydroxychloroquine was discontinued and the patient was started on methotrexate therapy that resulted in resolution of her rashes in a week.
A 60-year-old male presented with complaints of fever, chills, cough, and shortness of breath. He denied abdominal pain, urgency, dysuria, or hematuria. His laboratory data revealed an elevated white blood cell count and lactic acid, and one set of blood culture stained positive for gram-positive cocci. He was empirically started on intravenous antibiotics. On the next hospital day, the patient complained of hematuria and lower abdominal discomfort. A computed tomography scan of his abdomen and pelvis was obtained that revealed a focal hypodensity relating to prostate abscess, which was subsequently confirmed on magnetic resonance imaging of the prostate. Final report of blood cultures stated methicillin-resistant Staphylococcus aureus. He was treated with intravenous vancomycin and transurethral resection and deroofing of the prostate gland with drainage that resulted in complete resolution of his symptoms.
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