A case report of a fulminant Aeromonas hydrophila soft tissue infection in a patient with acute lymphoblastic leukemia harboring a rare translocation

Abstract

Introduction

Aeromonads are gram-negative opportunistic bacteria, mainly found in aquatic environments. Hematologic patients are particularly at risk of Aeromonas soft tissue infections and septicemia, especially during chemotherapy-induced neutropenia.

Case description

A 46-year-old man was diagnosed with acute lymphoblastic leukemia characterized by the rare t(12;17)(p13;q21)/TAF15-ZNF384 aberration. On day 22 of chemotherapy, he developed febrile neutropenia followed by necrotizing fasciitis in his upper right extremity. Despite appropriate antibiotic therapy and prompt surgical intervention, he died within 36 h after the appearance of a fever. A multi-sensitive Aeromonas hydrophila was isolated from all cultural sites.

Discussion and conclusions

In a previous paper we characterized the patient’s aberration with cytogenetic and FISH analysis. Here, we provide details regarding the patient’s rapidly progressing infection and underline the importance of maintaining high clinical suspicion of Aeromonas infections in acute leukemia. Given the unusually rapid progression of an infection caused by a rare non-resistant pathogen, and after considering data on the implication of metalloproteinase function in immune system regulation, a correlation between risk of severe infection and TAF15-ZNF384 aberrated acute lymphoblastic leukemia cannot be ruled out.

Keywords:

• Aeromonas
• acute lymphoblastic leukemia
• skin and soft tissue infection
• t(12;17)(p13;q21)
• TAF15-ZNF384

Transparency

Declaration of funding

The authors have no funding sources to declare.

Disclosure financial/other relationships

The authors declare that they have no competing interests. Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Author contributions

P.D. conceived of the presented idea. E.C. performed the literature review. P.D. and E.C. wrote the manuscript. P.D., K.Z., N.G., M.P. and N.V. took part in the clinical management of the presented case and collected relevant clinical data. N.V. supervised the project. All authors provided critical feedback and contributed to the final version of the manuscript.

Acknowledgements

Authors wish to thank Ms. Evita C Alexopoulos for copyediting the final manuscript and the Radium Hospital Foundation, Oslo, Norway for supporting the FISH experiments related to the ZNF384 and TAF15 gene rearrangement.

Data  availability  statement

Presented data are available from the corresponding author on reasonable request.

Ethics statement

Every effort was made to preserve the anonymity of the patient. Moreover, written informed consent from the patient’s next of kin was obtained.