A previously healthy 37‐year‐old white woman was initially admitted to the hospital with fever, nausea, and vomiting of 2 days' duration. At admission, her blood pressure was 94/60, and temperature was 102°F. Laboratory data were notable for white blood cell count 8500/μL, hemoglobin 11.4 g %, platelet count 358,000/μL, BUN 15 mg/dL, and creatinine 0.6 mg/dL Liver function tests were normal. Peripheral smear was normal without any bands or abnormal cells. Chest x‐ray was negative. Urinalysis was normal and urine cultures were negative. The patient was empirically started on antibiotics which included vancomycin and doripenem. A CT abdomen and chest were negative for source of infection and lymphadenopathy. Spleen and liver were normal. Blood cultures grew Acinetobacter baumannii. Doripenem was continued. Patient recovered and was discharged. Three months after this admission, the patient went to her primary care provider with complaints of generalized weakness and easy bruising. A complete blood count at this time revealed a white blood cell count of 98.000/μl, hemoglobin 7.3 g/dL, platelet count 13,000/μL, prothrombin lime 12.4, and partial thromboplastin time 24. Peripheral smear revealed immature cells with blasts, few nucleated red blood cells, and rare mature lymphocytes, consistent with acule leukemia. Flow cylomelry and immunophenotyping revealed acule myeloid leukemia (AML). The patient was started on induction chemotherapy.
Acinetobacter baumannii has been reported as an important nosocomial pathogen. However, community‐acquired A. baumannii bacteremia (CAAB) is a very rare entity. It has been reported in immunocompromised patients and those with malignancy, with malignancy being the most frequent underlying disease. The most common source for this bacteremia is usually pneumonia. No source of bacteremia could be found in our patient. Our patient was a young and healthy woman with no previous hospitalizations or no known comorbidities at the time of presentation. However, her presentation with AML 3 months after the CAAB episode indicates CAAB was an indicator of her underlying malignancy.
We report this case to illustrate that CAAB is a very rare entity and occurs commonly in patients with underlying malignancy. Patients presenting with CAAB but with no other comorbidities should be carefully evaluated for underlying malignancy. Age‐specific general recommendations for screening for malignancy must be applied. Patients should be carefully followed in the office after discharge.
K. Koduru, none; T. Hamieh, none; P. Koduru, none; G. Gunwant, none.