Pseudohemoptysis Due to Serratia marcescens

Abstract

An 88-year-old man with no history of pulmonary disease was admitted following syncope. Examination of the lungs at presentation was unremarkable and chest radiograph was clear. The patient required mechanical ventilation for several days due to his altered mental status. On hospital day four, the patient developed fever, leukocytosis, and red secretions from the endotracheal tube. Bronchoscopy revealed multiple red lesions throughout the proximal airways (Panel a, arrow), but no active bleeding. Bronchial washings were red-colored (Panel b), but no red blood cells were seen under microscopy. Subsequently, cultures were positive for Serratia marcescens. Pseudohemoptysis, or the appearance of red colored sputum without the presence of red blood cells, is a well-described manifestation of Serratia marcescens infection. This phenomenon is attributed to the organism’s production of the red pigment prodigiosin at room temperature (Fig. 1). Figure 1 a. Bronchoscopic view with arrow pointing to red lesions. b. Red-colored bronchial washings. Serratia marcescens is a common environmental organism and an important cause of nosocomial infection.1 Data from the US show that Serratia species were recovered in 4.1 % of hospitalized patients with pneumonia.2 Nosocomial pneumonia attributed to Serratia marcescens has been traced to numerous sources, including nebulizers,3 inhaled medications,4 and bronchoscope equipment.5 Our patient was treated with 10 days of doripenem, with clinical improvement and resolution of the pseudohemoptysis.