This is a 64‐year‐old man who presented with a tender, swollen, red left elbow. He reported no subjective levers. He had exfoliated the skin on his elbow using a stainless steel file. He had then applied a petroleum‐based ointment that he normally used as a lip balm. His elbow had become increasingly red, tender and swollen over the 12 hours preceding presentation. His past medical history was significant for prior arthroscopic knee surgeries, rotalor cuff repair, and renal stones. He had a pacemaker placed for bradycardia 3 months prior He was otherwise in good health. Physical exam was significant for a normal temperature, heart rate and blood pressure of 167/95 mmHg. Left upper‐extremity edema was present from his axilla to fingertips. There was blanching erythema from his axilla to his wrist confined to Ihe medial aspect of his arm. There was tender axillary adenopathy. Initial laboratory data showed a normal CBC and a normal basic metabolic panel. Blood cultures were obtained. At 24 hours blood cultures were positive for Gram‐positive cocci. Final identification was Rothia mucilaginosa. Susceptibilities were not performed for this organism. The patient was treated successfully with 10 days of intravenous vancomycin.
Rothia mucilaginosa is a rarely identified pathogenic organism. It has been identified as a pathogen in immunocompromised patients and those with invasive instrumentation. Susceptibility testing methods have not been validated for this organism. To the best of our knowledge, this is the first report of an invasive R. mucilaginosa infection in a nonimmunocompromised patient. The apparent source of this infection was from application of lip balm to open skin. R. mucilaginosa is a known inhabitant of the oral cavity and upper respiratory tract.
R. mucilaginosa is an emerging pathogen for immunocompromised patients and should now be considered a potential emerging pathogen in nonimmunocompromised patients.
J. Lindsey, none; K. M. Baker, none.