Case Presentation: A 68-year-old African-American woman with known history of refractory IgG kappa multiple myeloma presented with fever, congestion, and purulent drainage from both ears that had been progressively worsening over the past week. She initially attributed her symptoms to sinus infection and self-treated with a Neti Pot using non-sterile water. The Neti Pot was several months old and had not been disinfected since purchase.
Physical examination revealed an acutely ill-appearing woman with obstructed visualization of both ears due to purulent drainage. The remainder of her physical examination was unremarkable and she did not have indwelling intravascular access. Computed tomography (CT) and magnetic resonance imaging (MRI) of the head and sinuses demonstrated fluid in the tympanic cavities and mastoid air cells bilaterally with paranasal sinus mucosal density and air fluid levels in the maxillary sinuses. Blood cultures grew Burkholderia cepacia susceptible to piperacillin-tazobactam and meropenem. She was treated with four weeks of intravenous (IV) piperacillin-tazobactam along with micro-debridement of both ears. She responded well to therapy, repeat blood cultures were sterile, and she made a complete recovery.
Discussion: Burkholderia cepacia is an aerobic gram-negative bacillus commonly seen in soil and moist environments and has propensity to survive in aquatic environments. Most cases of B. cepacia bacteremia reported in the literature are in patients with cystic fibrosis. However, B. cepacia has recently been identified as an important opportunistic pathogen in hospitalized and immunocompromised patients. There have been several studies reporting hospital outbreaks of B. cepacia emerging from a single contaminated source such as nebulizer solutions, medical devices, intravenous solutions, and mouthwash. A case-control study among intensive care unit (ICU) patients without cystic fibrosis demonstrated B. cepacia bacteremia in patients with recent bronchoscopies, tracheostomy, and/or presence of a central line before bacterial isolation. There have even been reports documenting the growth of B. cepacia in water systems and colonizing bottled water. B. cepacia pseudobacteremia is also noted in numerous reports, but true bacteremia caused by B. cepacia is rare. In our case, the patient was not hospitalized in the ICU, did not have cystic fibrosis, did not have an indwelling line, and had not had invasive procedures. Instead, this was a unique case of B. cepacia isolation caused by probable environmental contamination after improper use of a Neti Pot with non-sterile water. It is important to note B. cepacia is often resistant to many common antibiotics and therefore treatment plans can be complicated. Management primarily focuses on prevention of the infection.
Conclusions: It is important to educate immunocompromised patients about the dangers of common home remedies, which may increase their risk of infections.