Title : Critical bloodstream infection caused by chromobacterium violaceum: A case report in a 15-year-old male with sepsis-induced cardiogenic shock and purpura fulminans
Abstract:
Chromobacterium violaceum (C. violaceum) is a gram-negative and facultative anaerobic bacillus that is widespread in the soil and water in tropical and subtropical regions. Knowledge of the pathogenesis of C. violaceum has increased over the decades since the first case of human infection with C. violaceum was reported in 1927. However, there are still fewer than 200 reported cases worldwide, and accurate incidence statistics are lacking. Although C. violaceum rarely infects humans, the mortality rate for C. violaceum infection is over 50%.
Here, we report a case of a 15-year-old male who developed a critical bloodstream infection caused by C. violaceum, which progressed to cardiogenic shock and multi-organ abscesses (liver and lung), together with purpura fulminans (PF)-associated symmetric peripheral gangrene (SPG). On the basis of C. violaceum susceptibility testing, a combination of trimethoprim-sulfamethoxazole (TMP-SMX, 0.96 g orally every 6 hours), amikacin (0.4 g intravenously every 12 hours), and doxycycline (0.1 g orally every 12 hours) was adopted, and the bloodstream infection and multi-organ abscesses were subsequently cured. The refractory sepsis-induced cardiogenic shock was reversed in time with venoarterial extracorporeal membrane oxygenation (VA ECMO). In addition, C. violaceum-related purpura fulminans, reported here for the first time, was improved after treatment with enoxaparin and regular debridement to the extent that disabling amputation was avoided.
In conclusion, this case report demonstrates the virulence of C. violaceum with the aim of raising clinical awareness of this disease. In critical patients, combined use of antibacterial drugs based on susceptibility testing and proactive organ support is important. Prior to microbiological confirmation, profiles of traumatic history in tropical and subtropical areas, specific skin lesions, multi-organ abscesses, and rapid progression can guide initial treatment.
