A diabetic patient with chronic heart failure developed necrotizing fasciitis and bacteremia caused by Chryseobacterium meningosepticum, which rapidly evolved into death, even with fasciotomy and intensive care. A review of the English literature found 10 cases of soft tissue infection caused by C. meningosepticum, which is rarely acquired in the community.
CASE REPORTA 62-year-old diabetic man with coronary artery and rheumatic heart disease received a mitral valve replacement by mechanical valve and coronary artery bypass in October 2000. He took regular medications, including oral warfarin, glibenclamide, metformin hydrochloride (Glucophage), digoxin, and furosemide. In January 2005, he developed bilateral lower-leg edema, progressive dyspnea, orthopnea, and a decline in urine output for 3 days until erythema and exquisite pain of the left lower leg made him visit the emergency department of the hospital. He denied fever, chills, and a history of trauma and contact with water. On initial physical examination, he had a blood pressure of 66/48 mm Hg, a pulse rate of 78/min, a body temperature of 37.8°C, and a respiratory rate of 22/min. He had feeling in his left lower limb. Some bullae with clear content and erythematous skin were observed. Initial laboratory tests showed leukocytosis with a left shift (17,200 cells/ mm 3 with 30% band form). The serum level of C-reactive protein was 39.1 mg/liter. Acute renal failure (serum creatinine, 2.4 mg/dl) and an elevated aspartate aminotransferase level (64 U/liter) were found. Chest X-ray film showed marked cardiomegaly and bilateral pulmonary congestion. Cardiac sonography revealed four-chamber dilation and global hypokinesis with impaired performance of the left ventricle. Medical therapy for cardiogenic shock was instituted, and empirical antibiotic with intravenous cefpirome was administrated. Color duplex sonography of the left lower leg revealed no evidence of deep vein thrombosis.On the next day, more tenderness and hemorrhagic bullae were noted for his left lower leg (Fig. 1). Intravenous ciprofloxacin was initiated based on initial susceptibility results by the disk diffusion technique. On the third day, fasciotomy was undergone, and he was then admitted into the intensive care unit. However, clinical evolution was rapid, and a loss of consciousness, anuria, and multiple organ failure developed. He died on the fourth day.Nonfermentative, catalase-and oxidase-positive gram-negative rods were discovered in the blood and wound, and both yielded slightly yellow-pigmented colonies on blood agar after 24 h of incubation. They hydrolyzed esculin and could produce acid from mannitol (13, 15). They were identified as Chryseobacterium meningosepticum by means of the API 20NE system (BioMerieux, Marcy l'Etoile, France) and the GNI Plus system (Vitek Systems, BioMerieux, Vitek, Hazelwood, Mo.). The MICs of selected antimicrobial agents measured by E-test strips (AB Biodisk, Solona, Sweden) were 0.38 g/ml for levofloxacin, 0.25 g/ml for ciprofloxacin, 0.06-0.32 g/ml for ...