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Clinical Infection & Immunity

Letter to the Editor

Volume 5, Number 2, June 2020, pages 49-50

Disseminated Corynebacterium striatum Infection in a Patient With Recurrent Acute Lymphoblastic Leukemia

Corynebacterium striatum is ubiquitous in the environment, and represents a part of the normal flora of human skin and mucous membranes. However, it has been recognized as a pathogen in hospitalized patients and/or immunocompromised hosts, especially patients whose skin has been injured by a medical device [1-3]. Here, we present the case of a patient with recurrent acute lymphoblastic leukemia, in which an autopsy revealed a disseminated Corynebacterium striatum infection.

A 68-year-old female was diagnosed with Ph-negative acute lymphoblastic leukemia, and treated with chemotherapy (the hyper-CVAD/MA regimen), resulting in complete remission. Two years later, she was referred to our hospital after suffering a fever for 2 weeks. Laboratory tests showed a white blood cell count of 28,000/µL with a blast frequency of 67%, a hemoglobin concentration of 13.6 g/dL, and a platelet count of 194,000/µL. A bone marrow examination revealed a hypercellular bone marrow (lymphoblast frequency: 68.2%) without any chromosomal abnormalities. Hence, a diagnosis of relapsed acute lymphoblastic leukemia was made. The patient was started on clofarabine monotherapy via a central venous catheter, which was inserted into her right subclavicular vein. However, after two courses of clofarabine her leukemia had progressed. She wanted to receive outpatient treatment combined with supportive care alone because of her quality of life; hence, she was discharged to her home after the second course of clofarabine. Within 1 month, she was brought to our emergency department with dyspnea. At this time, peripheral blood analysis revealed a white blood cell count of 100/µL, a hemoglobin concentration of 8.9 g/dL, and a platelet count of 60,000/µL. Serological tests produced the following results: creatinine level: 0.88 mg/dL, total bilirubin level: 0.9 mg/dL, C-reactive protein level: 10.96 mg/dL. Only best supportive care was administered because the patient’s condition seemed to be terminal, and she eventually died of respiratory insufficiency 3 months after the diagnosis of relapse. A postmortem examination was performed. Sections of multiple organs revealed massive clusters of club-shaped bacilli, and Corynebacterium striatum grew from her lung tissue cultures (Fig. 1). Hence, a postmortem diagnosis of a disseminated Corynebacterium striatum infection was made.

Click for large image

Figure 1. Gram-positive bacilli (Corynebacterium striatum) were revealed by Gram staining of lung tissue cultures ((a) × 1,000). Histopathological examinations of multiple organs demonstrated clusters of Corynebacterium striatum (H&E staining; (b) lung, × 400; inset, × 1,000; (c) kidney, × 400; inset, × 1,000; (d) liver, × 400; inset, × 1,000; (e) pancreas, × 200; (f) myocardium, × 200; (g) thyroid, × 200; (h) esophagus, × 200). H&E: hematoxylin and eosin.

Recently, a large amount of autopsy data regarding hematological malignancies have been reported [4]. Although the latter study mainly focused on lung pathology, bacterial infections were relatively rare in the reported cardiovascular, liver, gastrointestinal, and genitourinary lesions. To the best of our knowledge, there have not been any previous reports about the autopsy detection of a disseminated Corynebacterium striatum infection affecting multiple organs, as was found in the present case. It seemed that the etiologies of the disseminated Corynebacterium striatum infection seen in the present case included the recurrent leukemia itself and hematological toxicities caused by chemotherapy, which induced severe immunosuppression. In addition, the replacement of the central venous catheter might have triggered the dissemination of the infection through the bloodstream. Hence, clinicians in hematology departments that are in charge of patients who often require intensive chemotherapy via central nervous catheters should be aware that Corynebacterium striatum infections can occur in such situations.

Acknowledgments

None to declare.

Financial Disclosure

None to declare.

Conflict of Interest

The authors declare that there is no conflict of interest.

Informed Consent

The patient’s son described in the letter had given informed consent for the paper to be published.

Author Contributions

All authors contributed to the editing of the manuscript. MM, YS, and KK wrote the manuscript and prepared the figures.

Data Availability

The authors declare that data supporting the findings of this study are available within the article.

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