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Abstract
BackgroundLeptotrichia species are aerotolerant, Gram-negative fusiform bacteria. Cases of bacteremia caused by Leptotrichia trevisanii in immunocompromised patients have been rarely reported.Case presentationA 33-year-old female with systemic lupus erythematosus (SLE) was admitted to the department of rheumatology with bleeding from a mucosal ulcer. One month previously, she had visited our hospital and begun to receive methotrexate therapy, but mis-dosed for nearly 1 month at home. Methotrexate toxicity resulted in a severe oral ulcer and bone marrow suppression. On day-7 of hospital admission, she developed a fever, and Gram-negative rods (Leptotrichia trevisanii) were detected in blood cultures. She was diagnosed with methotrexate poisoning followed by L. trevisanii bacteremia. After antibiotic and detoxification therapy, she recovered from bacteremia, and the oral ulcer and bone-marrow suppression improved obviously.ConclusionsThis is the first reported case of Leptotrichia trevisanii bacteremia in a SLE patient who took mis-dosed an immunosuppressant and had an oral mucosal lesion.
Highlights
Leptotrichia species are aerotolerant, Gram-negative fusiform bacteria
Leptotrichia species have been implicated in periodontal disease, endocarditis, chorioamnionitis and arthritis, especially in immunocompromised patients [2,3,4]
Leptotrichia trevisanii bacteremia has been reported in patients with acute myeloid leukemia [5, 6], myelodysplastic syndrome [7] and febrile neutropenia [8]
Summary
Leptotrichia species are aerotolerant, Gram-negative fusiform bacteria that can inhabit the oral cavity, intestinal tract and genitalia [1]. Case presentation A 33-year-old female was diagnosed with SLE 3 years previously in another hospital. She visited our hospital in May 2018 due to pain in lower back and began to take methotrexate. Advice from her physician was methotrexate (10 mg) once a week, but she made the mistake of taking this dose every day She developed severe bleeding from an ulcer in the oral mucosa, and was admitted to our hospital 1 month later. She was diagnosed with SLE and methotrexate poisoning. Sepsis had resolved and there was no recurrence of bacteremia
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