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Severe cellulitis caused by Achromobacter xylosoxidans after allogeneic hematopoietic stem cell transplantation
Authors:Yu Oyama  Megumi Yasunaga  Akira Honda  Hiroaki Maki  Yosuke Masamoto  Tatsuya Kobayashi  Yoshitaka Wakabayashi  Shu Okugawa  Kyoji Moriya  Mineo Kurokawa
Affiliation:1. Department of Hematology and Oncology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan;2. Department of Infection Control and Prevention, Faculty of Medicine, The University of Tokyo, Japan;3. Department of Cell Therapy and Transplantation Medicine, The University of Tokyo Hospital, Tokyo, Japan;1. Chiba Children’s Hospital, Division of Infectious Diseases, Chiba, Japan;2. Chiba University Hospital, Department of Clinical Laboratory, Chiba, Japan;3. Department of Mycobacterium Reference and Research, The Research Institute of Tuberculosis, Japan Anti-tuberculosis Association, Kiyose, Japan;4. Basic Mycobacteriosis, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan;1. Department of Hematology and Oncology, Graduate School of Medicine, Kyoto University, Kyoto, Japan;2. Department of Hematology, Kansai Electrical Power Hospital, Osaka, Japan;3. Department of Hematology, Kyoto-Katsura Hospital, Kyoto, Japan;4. Senri Kinran University, Osaka, Japan;1. Department of Microbiology, Tokyo Medical University, Tokyo, Japan;2. Department of Infectious Diseases, St Luke''s International Hospital, Tokyo, Japan;3. Metaboscreen Company, Ltd., Kanagawa, Japan;4. Department of Microbiology, St. Marianna University School of Medicine, Kanagawa, Japan;5. Graduate School of Public Health, St. Luke''s International University, Tokyo, Japan;6. Department of Infectious Diseases, International University of Health and Welfare, Chiba, Japan;1. Infectious Disease Surveillance Center, National Institute of Infectious Diseases, 1-23-1 Toyama, Shinjuku-ku, Tokyo, 162-8640, Japan;2. Victorian Infectious Diseases Reference Laboratory, At the Peter Doherty Institute for Infection and Immunity, 792 Elizabeth St, Melbourne, VIC, 3004, Australia;3. Department of Health and Welfare, Akita Prefectural Government, 4-1-1 Sanno, Akita City, Akita, 010-8570, Japan;1. Medical School of Ege University, Division of Infectious Disease, Department of Pediatrics, Izmir, Turkey;2. Medical School of Ege University, Department of Microbiology and Infectious Diseases, Izmir, Turkey
Abstract:Achromobacter xylosoxidans (A. xylosoxidans) is an aerobic gram-negative bacillus and often isolated from aquatic environments. It is supposed to cause infections in patients with malignancy or immunodeficiency. It causes various healthcare-associated infections, but cellulitis is rare. Herein, we report the first case of sever cellulitis by A. xylosoxidans after allogeneic hematopoietic stem cell transplantation (HSCT). A 49-year-old man underwent allogeneic HSCT from 8/8 HLA-matched unrelated donor with myeloablative conditioning for relapsed acute myeloid leukemia. He developed skin chronic graft versus host disease 11 months after HSCT. During the prolonged treatment with prednisolone and cyclosporine, he developed cellulitis on his left leg and admitted to our hospital. Blood and exudate culture revealed A. xylosoxidans. Although empirical therapy with cefepime was ineffective, his symptoms were dramatically improved after administration of meropenem. To our knowledge, this is the first case of A. xylosoxidans cellulitis after allogeneic HSCT. A. xylosoxidans should be considered as a possible cause of cellulitis in post-allogeneic HSCT patients on prolonged immunosuppressive therapy.
Keywords:Cellulitis  Hematopoietic stem cell transplantation  Chronic graft versus host disease
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