Skin manifestation of Stenotrophomonas maltophilia infection--a case report and review article.
BACKGROUND
Stenotrophomonas maltophilia is an aerobic gram-negative bacillus that is a frequent coloniser of fluids used in the hospital setting. It causes infection in immunosuppressed hosts, especially those who are neutropaenic, on chemotherapy and broad spectrum antibiotics. Skin and soft tissue manifestations of Stenotrophomonas maltophilia infection are becoming an increasingly recognised entity; the clinical spectrum ranges from mucocutaneous, skin to soft tissue infections.


METHODS
We present a case of an 8-year-old girl with acute myeloid leukaemia who developed metastatic skin lesions secondary to Stenotrophomonas maltophilia bacteraemia. The authors reviewed a total of 24 reported cases of mucocutaneous, skin and soft tissue infections by Stenotrophomonas maltophilia. The presentations include metastatic cellulitis, primary cellulitis and infected mucocutaneous ulcers.


RESULTS
This is the first locally reported case of metastatic nodular skin lesions caused by Stenotrophomonas maltophilia bacteraemia. This is also the first reported paediatric case of embolic skin lesions caused by Stenotrophomonas maltophilia. Of the 6 cases of Stenotrophomonas maltophilia bacteraemia seen in the paediatric oncology patients from year 2000 to 2004 at our hospital, only 1 case developed metastatic skin lesions.


CONCLUSIONS
Stenotrophomonas maltophilia skin infection should be included into the list of differential diagnoses for metastatic skin lesions in neutropaenic patients, especially with an underlying haematologic malignancy who has received recent chemotherapy and broad spectrum antibiotics. Haematologic malignancy, transplantation, neutropaenic, immunosuppressive therapy and a high severity of illness score were important prognostic factors.
Teo
Wan Yee
WY
Department of Paediatric Medicine, Kandang Kerbau Women's & Children's Hospital, Singapore.
Chan
Mei Yoke
MY
Lam
Ching Mei
CM
Chong
Chia Yin
CY
D000208:Acute Disease; D000890:Anti-Infective Agents / Q000627:therapeutic use; D016470:Bacteremia / Q000453:epidemiology / Q000382:microbiology; D002481:Cellulitis / Q000453:epidemiology / Q000382:microbiology; D002648:Child; D015897:Comorbidity; D005260:Female; D016905:Gram-Negative Bacterial Infections / Q000150:complications*; D006801:Humans; D007951:Leukemia, Myeloid / Q000453:epidemiology*; D009503:Neutropenia / Q000453:epidemiology; D011379:Prognosis; D017192:Skin Diseases, Bacterial / Q000453:epidemiology*; D020615:Stenotrophomonas maltophilia; D015662:Trimethoprim, Sulfamethoxazole Drug Combination / Q000627:therapeutic use
D000890:Anti-Infective Agents; D015662:Trimethoprim, Sulfamethoxazole Drug Combination