(587) Rare Infections: A Case of Kytococcus Infection in an Immunocompromised Host

Introduction: Rare infections present a significant medical challenge due to limited experience in their diagnosis and management. Kytococcus is a Gram-positive, non-encapsulated, and aerobic bacteria, that can be found in the normal skin microbiome. The organism is an uncommon cause of infection in humans, but among immunosuppressed individuals, it has the potential for severe and even lethal infections. Kytococcus spp. can exhibit varied resistance to multiple antibiotics, complicating the treatment approach.

Description: This case involves a 44-year-old female patient with refractory acute myeloid leukemia, characterized by prolonged and severe neutropenia and an elevated peripheral blast count. She was undergoing rescue chemotherapy when she was admitted to the intensive care unit with septic shock and acute hypoxic respiratory failure. The chest X-ray revealed a right upper lobe pneumonia. Kytococcus sp. was isolated from both blood and sputum culture samples. A transthoracic echocardiogram showed a pulmonic valve vegetation, and a CT of the abdomen demonstrated an ill-defined hypoattenuating 3 cm liver mass concerning for an abscess. The patient refused a transesophageal echocardiogram. The treatment consisted of a 4-week course of weekly oritavancin, combined with 6-weeks of ceftaroline and meropenem. The patient succumbed 6 weeks after completing the antibiotic treatment, likely due to progression of the malignancy and other infectious diseases, such as recurrent candidemia and probable pulmonary Aspergillosis.

Discussion: This clinical case illustrates a typical presentation of Kytococcus, an organism that can cause serious infections such as sepsis, pneumonia, endocarditis and abscesses. Although endocarditis and abscess were not proven in this patient, these conditions are very typical features of Kytococcus. We do not believe that the cause of death was exclusively attributable to Kytococcus, but that the general context of the patient, with high blastemia and multiple co-infections. However, it is crucial to recognize that Kytococcus must be treated with multiple antibiotic therapy to achieve eradication. This case underscores the importance of considering Kytococcus as a significant pathogen. More research is needed to understand the pathogen's resistance and pathogenicity.