A Case of Pericarditis Due to Roseomonas Gilardii in a Patient with Angiosarcoma of the Pericardium

Abstract

Roseomonas gilardii is a Gram-negative slow growing coccobacillus that has been recognized as an opportunistic pathogen which can lead to infections, especially in immunocompromised and chronically ill patients. The organism is generally susceptible to carbapenems and aminoglycosides, but resistant to most of the cephalosporins. We report what we believe is the first case of a 72-year-old oncologic woman who developed a pericarditis caused by R. gilardii in Italy.Roseomonas gilardii is an aerobic Gram-negative coccobacillus, oxidative, non-fermentative, slow growing and pink-pigmented (1-2). The genus Roseomonas contains four named species (R. gilardii, R. mucosa, R. cervicalis and R. fauriae) and three unnamed genomospecies 4, 5 and 6 (3-4). The natural reservoir for Roseomonas infection is unknown (5). Although it has been isolated from water supplies (3, 6), it may also exist as a commensal in humans. R. gilardii is most frequently related to human infections, however human infections due to Roseomonas species are uncommon and the vast majority of reported infections are opportunistic and easy to treat but can cause disseminated infections, particularly in debilitated host (7). Some infection due to Roseomonas spp. have involved bacteraemia in persons with central venous catheters and underlying malignancies or other chronic diseases (8). Roseomonas strains have been most commonly isolated from middle-aged women with one of several underlying conditions, including cancer and diabetes. Previous studies reported that in 88% of Roseomonas case reports, the organism was isolated from the blood, respiratory problems occurred in 16%, wound infection in 8%, peritonitis in 4%, enteritis in 8%, kidney transplant infection in 4% and eye infection in 4% (3, 6, 9-10).A 72-year-old female was admitted to the emergency department for constrictive pericarditis and pericardial effusion of unknown aetiology and proliferative lesion suspected to be cardiac tumour. The patient reports a previous pericarditis in 2012, and loss of appetite and weight in the last six months. Full-body computed tomography (CT) examination demonstrated a marked thickening of the pericardium with solid plaques on the right side and pericardial effusion. Serum tumour marker studies revealed elevated CA125 and neuron specific enolace (NSE), but others, including CA19-9 and carcinoembryonic antigen (CEA) were within normal limits. A port was surgically inserted into the patient and successively a pericardiocentesis and a biopsy of the pericardium were performed. The histological and cytopathological examination by surgical biopsy of the pericardium confirmed the diagnosis of pericardial angiosarcoma.