Citrobacter Freundii Skin Infection in an Immunocompetent Subject Simulating Varicella: A Treatment-Resistant Case

Abstract

Citrobacter spp infections in immunocompetent subjects are rare and mainly involve the urinary and respiratory tracts. We report a case of Citrobacter freundii skin infection in an immunocompetent patient simulating varicella and having resisted empirical treatment of common bacterial skin infections on 3 occasions. The patient was 26-years-old and worked in a mining area in Kayes, Mali. He had no previous medical or surgical history and consulted for diffuse papulopustules on the integument, simulating chickenpox, for which he had received empirical treatments of common bacterial skin infections without success. In view of the persistence and appearance of new lesions, he consulted us on 2nd November 2021, where a bacteriology showed Citrobacter freundii. The patient was treated with ceftazidime and gentamycin with success (according to the patient). Citrobacter spp are facultative anaerobic Gram-negative bacilli of the Enterobacteriaceae family, frequently found in water, soil, food and the intestines of animals and humans. They are known to cause a wide spectrum of infections affecting the urinary tract, liver, biliary tract, peritoneum, intestines, bone, respiratory tract, endocardium, wounds, soft tissue, meninges and bloodstream in immunocompromised subjects. Our case is atypical in its presentation, immunocompetent subject, clinical form simulating chickenpox without extracutaneous involvement and which raised the resistance of opportunistic germs to antibiotics.