Central line-related bacteraemia due to Tsukamurella tyrosinosolvens in a haematology patient.

Abstract

CASEREPORT A 48-year-old female patient with a six-yearhistory ofnon-secretory multiple myeloma presented to hospital in September 2001 having felt generally unwell for the preceding two weeks. She lived in an urban area and had limited mobility. She described fevers withrigors on anumberofoccasions particularly associated with flushing of a Hickman line, which had been in situ since July 1999. Her white cell count was 2.7 x 109/1 and she was mildly pancytopaenic following a course of doxombicin and methylprednisolone, which she had received four weeks previously. Blood culture taken from the central line had grown Gram-positive bacilli and coagulase-negative staphylococci inthe first48 hours from both aerobic and anaerobic bottles drawn from the white and red lumens ofthe Hickman line. This episode was managed in the community as a central venous catheter infection with oral ciprofloxacin and intravenous teicoplanin as empirical therapy. On review two weeks later, following completion ofthe 10-day course of antibiotics, the patient continued to be unwell complaining of general malaise and furtherrigors.At this time, inthe absence ofany other source of infection, a decision was made to remove the catheter. She dramatically improved thereafter without further antimicrobial therapy.