Takagi Ikumi, Harada Naonori, Niki Makoto, Yamada Koichi, Makuuchi Yosuke, Kuno Masatomo, Takakuwa Teruhito, Okamura Hiroshi, Nishimoto Mitsutaka, Nakashima Yasuhiro, Koh Hideo, Kakeya Hiroshi, Hino Masayuki, Nakamae Hirohisa
Hematology, Graduate School of Medicine, Osaka Metropolitan University, Osaka, Japan.
Hematology, Graduate School of Medicine, Osaka Metropolitan University, Osaka, Japan.
Transplant Proc. 2023 Apr;55(3):706-710. doi: 10.1016/j.transproceed.2023.02.028. Epub 2023 Mar 17.
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.
嗜麦芽窄食单胞菌是一种机会致病菌，具有对多种抗生素的固有和获得性耐药机制。嗜麦芽窄食单胞菌引起的血流感染是一种潜在的致命并发症，尤其是在脐带血移植（CBT）受者中。关于嗜麦芽窄食单胞菌皮肤和软组织感染（SSTIs）的报道较少，包括转移性蜂窝织炎和坏疽性深脓疱，这些感染被报告为伤口感染。嗜麦芽窄食单胞菌引起的转移性蜂窝织炎病变通常据报道有压痛、红斑，并显示皮下温暖浸润。关于嗜麦芽窄食单胞菌引起的转移性蜂窝织炎的临床过程只有少数可用报告。我们遇到了一例在接受CBT的患者中发生伴有暴发性和广泛剥脱的转移性蜂窝织炎的病例。尽管控制了嗜麦芽窄食单胞菌引起的血流感染，但由于皮肤屏障的破坏，患者死于继发性真菌感染。我们的病例强调，嗜麦芽窄食单胞菌引起的SSTIs可在严重免疫受损宿主中，包括接受类固醇治疗的CBT受者中，导致伴有全身性表皮剥脱的暴发性转移性蜂窝织炎意外发生。
