Recurrent sepsis with P. aeruginosa in a patient with myelodysplastic syndrome and multiple comorbidities – case report and review of physiopathological mechanisms
Recurrent sepsis with P. aeruginosa in a patient with myelodysplastic syndrome and multiple comorbidities – case report and review of physiopathological mechanisms

Summary/Abstract: Introduction Febrile neutropenia is a clinical emergency that can develop as a result of multiple mechanisms. The evolution of neutropenia is highly dependent on that of the underlying disease, and identification of comorbidities is essential. In cases of Gram-negative bacteremia, the mortality rate can reach 18%. Case report We report the case of a patient with myelodysplastic syndrome and neutropenia among multiple comorbidities, hospitalized for fever, chills and altered clinical state two weeks after having been discharged from the hospital following the resolution of sepsis with P. aeruginosa. The clinical exam revealed active intestinal bleeding and discrete wet rales in the middle one-third of the right pulmonary lung field. An initial diagnosis was neutropenic fever, and empirical intravenous treatment with meropenem, vancomycin and caspofungin was started. A comprehensive laboratory evaluation revealed liver and kidney impairment of recent onset, blood cultures came back positive for P. aeruginosa, and the diagnosis of recurrent sepsis with P. aeruginosa was established. Antimicrobial treatment was de-escalated from meropenem to piperacillin-tazobactam, levofloxacin was added, vancomycin was stopped, and caspofungin was replaced with fluconazole, with favorable evolution, remission of fever within three days, marked reduction of the inflammatory syndrome, and remission of organ impairment. Treatment was continued for 10 days before the patient was discharged with the recommendation to continue prophylaxis with levofloxacin and fluconazole for the duration of severe neutropenia and to return for periodic evaluation in our clinic. Conclusions The recurrent sepsis episodes in this patient reflect primarily the neutropenic status, but comorbidities could also contribute to a certain degree of immunodeficiency. The long-term management of the infectious risk is a complex issue, including antibiotic and antifungal prophylaxis, due to the anticipated persistent neutropenia.

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