The clinical significance of Dietzia papillomatosis is for the moment limited to the rare skin disease confluent and reticulated papillomatosis. We present a case of infection with D. papillomatosis in a 2-year-old boy with known syringomyelia. The microbiological diagnosis was done using 16S rRNA gene sequencing. This is the first report of bacteremia with D. papillomatosis.
CASE REPORTA 2-year-old boy was approximately 5 months earlier diagnosed to have syringomyelia. As part of the syringomyelia elucidation, a cerebrospinal fluid (CSF) sample was obtained and tested for Borrelia IgG and IgM antibodies, and PCR was performed for herpes simplex and varicella-zoster; all were negative. In addition, a Gram stain was performed, but no bacteria were seen and the culture was negative. CSF leukocytes were at a level of 13 ϫ 10 6 /ml, but other parameters were reported normal. The patient had a ventriculoperitoneal shunt inserted for treatment of the syringomyelia. Due to malfunction of the shunt, the patient had an uncomplicated planned shunt revision. The day after the shunt revision, the boy was readmitted to the pediatric department due to high fever (39.2°C). He had a discrete truncal maculopapular exanthem but was not septic. He was suspected of having a viral infection. Chest X ray was normal, and there was no obvious focus of his infection. Two days later, the symptoms were unchanged, but the C-reactive protein rose from 9 to 108 mg/liter (normal value, Ͻ10 mg/liter), and his leukocyte count remained normal. A blood culture was obtained, and treatment with intravenous cefuroxime (100 mg/kg divided into three daily doses) was initiated. After another 2 days, the fever disappeared and the exanthem faded. Blood culture identified Dietzia papillomatosis by 16S rRNA gene PCR and sequencing. The boy was treated with cefuroxime for 4 days and then switched to oral amoxicillin, 36 mg/kg, for another 3 days and discharged. A blood culture, taken after antibiotic treatment was terminated, remained negative.The Dietzia species is an aerobic, Gram-positive coccus or short rod belonging to the group of actinomycetes. On the basis of its colony appearance and its microscopic resemblance, it has been classified as a Rhodococcus species. Gram staining of positive aerobic blood culture obtained from a peripheral vein revealed Gram-positive bacteria with an alternating morphology of cocci in clusters and coryneform rods. Blood was plated on blood agar and chocolate agar (Statens Serum Institute, Copenhagen, Denmark). The bacteria grew poorly on the first day under aerobic conditions and were later incubated on chocolate plates in a CO 2 atmosphere where growth was significantly improved. Repeated microscopy of colonies showed small Gram-positive rods. Fluorescence in situ hybridization using peptide nucleic acid probes (PNA-FISH; AdvanDx, Vedbaek, Denmark) using the probe set for identification of Staphylococcus aureus and coagulase-negative staphylococci was negative. Matrix-assisted laser desorption ionization-time of flight ...