Fulminant Metastatic Cellulitis Caused by Stenotrophomonas Maltophilia Infection and Subsequent Candida Parapsilosis Fungemia After Cord Blood Transplantation.

Abstract

Stenotrophomonas maltophilia is known to be an opportunistic pathogen with intrinsic and acquired resistance mechanisms to multiple antibiotics. Bloodstream infection caused by S. maltophilia is a potentially fatal complication, especially in recipients of umbilical cord blood transplantation (CBT). Infrequent reports of S. maltophilia skin and soft tissue infections (SSTIs), including metastatic cellulitis and ecthyma gangrenosum, have been reported as wound infections. Metastatic cellulitis lesions due to S. maltophilia are typically reported to be tender, erythematous, and to show warm subcutaneous infiltration. There are only a few available reports about the clinical course of metastatic cellulitis due to S. maltophilia. We experienced a case involving the development of metastatic cellulitis with fulminant and extensive exfoliation in a patient who underwent CBT. Despite controlling the bloodstream infection caused by S. maltophilia, the patient succumbed to secondary fungal infection due to the devastation of the skin barrier. Our case highlights that SSTIs due to S. maltophilia can cause the unexpected development of fulminant metastatic cellulitis with systemic epidermal peeling in severely immunocompromised hosts, including CBT recipients undergoing steroid therapy.

• Authors: Ikumi Takagi, Naonori Harada, Makoto Niki, Koichi Yamada, Yosuke Makuuchi, Masatomo Kuno, Teruhito Takakuwa, Hiroshi Okamura, Mitsutaka Nishimoto, Yasuhiro Nakashima, Hideo Koh, Hiroshi Kakeya, Masayuki Hino, Hirohisa Nakamae
• Journal: Transplantation proceedings (Transplant Proc) Vol. 55 Issue 3 Pg. 706-710 (Apr 2023) ISSN: 1873-2623 [Electronic] United States
• PMID: 36934053 (Publication Type: Journal Article)
• Copyright: Copyright © 2023 Elsevier Inc. All rights reserved.

Chemical References

• Anti-Bacterial Agents

Topics

• Humans
• Stenotrophomonas maltophilia
• Cellulitis (complications, drug therapy)
• Candida parapsilosis
• Fungemia (complications, drug therapy)
• Cord Blood Stem Cell Transplantation (adverse effects)
• Anti-Bacterial Agents (therapeutic use)
• Gram-Negative Bacterial Infections (diagnosis, drug therapy)