Introduction: Cellulosimicrobium cellulans is a rare human pathogen that is associated with chronic immunosuppression, such as human immunodeficiency virus infection, posttransplantation or end-stage renal disease.Case presentation: A 59-year old man with a past medical history of significant cardiovascular, cerebrovascular and peripheral vascular disease was admitted to the intensive care unit (ICU) with intractable seizures. Physical examination, radiographic imaging and culture results suggested the patient had developed metabolic encephalopathy due to pneumonia caused by Staphylococcus aureus and Moraxella catarrhalis. The patient recovered neurologically with the use of broad-spectrum antibiotics but developed acute renal failure during his stay. Seven days later, he relapsed into seizure activity and two separate blood cultures grew Cellulosimicrobium cellulans. Despite maximal antibiotic therapy, the patient continued to deteriorate. After 16 days, the patient's family withdrew care and he subsequently died.
Conclusion:We report the isolation of Cellulosimicrobium cellulans from a patient who developed acute renal failure following a prolonged stay in the ICU for sepsis encephalopathy.Keywords: 16S rRNA sequencing; acute renal failure; antimicrobial therapy; Cellulosimicrobium cellulans.
Case reportA 59-year-old man was admitted to the intensive care unit (ICU) with intractable seizures. His past medical history was significant for ischaemic heart disease with two previous myocardial infarctions, peripheral vascular disease requiring a left femoral-femoral bypass and a right femoral-popliteal bypass surgery, chronic obstructive pulmonary disease, dyslipidemia, and a prior admission to the ICU for pneumonia and septicemia. Four months earlier, he had suffered a stroke in the left middle cerebral artery region, leaving him with word-finding difficulties and confusion.On physical examination, the patient was confused, tachycardic (heart rate 120) and tachypneic (respiratory rate of 40). He had decreased air entry and crackles on auscultation of both lungs, and the rest of his physical examination was unremarkable. Laboratory tests showed a normal blood cell count, electrolytes, urea and creatinine. The patient's venous blood gas analysis pH was 7.04, with a partial CO 2 pressure of 96 and an elevated anion gap of 16. He He was intubated and underwent a computed tomography scan of his head, which showed old cerebral infarcts in both hemispheres, generalized atrophy of the brain, and no abscess or haemorrhage. A chest X-ray demonstrated diffuse pulmonary oedema with possible underlying pneumonia. Electroencephalogram recordings revealed moderate metabolic encephalopathy without a clear seizure focus. A lumbar puncture yielded normal results.Empirical treatment with intravenous piperacillin-tazobactam (4.5 g every 6 h) and acyclovir (1500 mg initial