Case Presentation: 63-year-old male with past medical history of diabetes mellitus complicated by neuropathy, hypertension and recurrent UTIs presented with 1 week history of nausea, decreased oral intake and malaise. He endorsed dysuria and left flank pain. Upon admission, he was afebrile and normotensive but slightly tachycardic. Initial labs revealed WBC 21.1, Creatinine 1.56, increased from baseline of 0.99, UA showed large leukocyte esterase, WBC 30-50, 4+ bacteria. He was initially started on vancomycin and meropenem for suspected left pyelonephritis. Urine culture grew multiple organisms, including torulopsis glabrata. Blood culture grew Myroides species in 4/4 bottles. Renal ultrasound did not show the left kidney well but the right kidney was without abnormalities. Infectious disease service was consulted, who recommended stopping vancomycin and adding gentamicin due to multi-drug resistance. He was eventually discharged home on ciprofloxacin for a total of 14 days and follow-up with primary care.
Discussion: Bacteria of the genus Myroides (Myroides spp.) are rare opportunistic pathogens, often found in environmental sources such as soil and water. Despite their low virulence, the bacteria are becoming increasingly drug-resistant and often present a dilemma in treatment. Nevertheless, Myroides spp. has been reported in various clinical settings and clinician should remain alert to the possibility of this organism as an etiologic agent for invasive infection, especially in the immunocompromised.
Conclusions: Myroides spp. are aerobic gram-negative bacteria that cause rare opportunistic infections. Although there have been only 48 reported cases of Myroides spp., it is important to recognize the bacteria as a possible etiology for infection, especially given its propensity to develop multi-drug resistance and cause significant disease in the immunocompromised population. We present the case of a diabetic patient that developed Myroides spp. bacteremia secondary to pyelonephritis.