Bacillus Cereus bacteremia complicated by brain abscess in a severely immunocompromised patient: Addressing importance of early recognition and challenges in diagnosis

David Schoenfeld; Dasom Lee; John A Arrington; John Greene; Olga Klinkova

doi:10.1016/j.idcr.2022.e01525

Bacillus Cereus bacteremia complicated by brain abscess in a severely immunocompromised patient: Addressing importance of early recognition and challenges in diagnosis

IDCases. 2022 Jun 6:29:e01525. doi: 10.1016/j.idcr.2022.e01525. eCollection 2022.

Authors

David Schoenfeld¹, Dasom Lee¹, John A Arrington², John Greene³, Olga Klinkova³

Affiliations

¹ Department of Internal Medicine, University of South Florida, 17 Davis Blvd., Suite 308, Tampa, FL 33606, USA.
² Department of Radiology, Moffitt Cancer Center, 12902 USF Magnolia Drive, Tampa, FL 33612, USA.
³ Infectious Disease Division, Moffitt Cancer Center, 12902 USF Magnolia Drive, Tampa, FL 33612, USA.

Abstract

Bacillus cereus (B. cereus) is a known cause of a food poisoning in the general population. However, it can cause life-threatening sepsis and shock in severely immunocompromised patients with hematologic malignancies, which frequently lead to central nervous system (CNS) infections associated with high mortality and morbidity. In this case report, we describe a patient with a newly diagnosed acute myeloid leukemia that underwent induction chemotherapy and developed B. cereus infection that was associated with septic shock and brain abscesses. Definitive diagnosis of multiple brain abscesses was not manifested with routine microbiological investigation but required the use of 16S ribosomal (rRNA) gene polymerase chain reaction (PCR) sequencing of the resected brain lesion. The patient was eventually treated with 8-week course of intravenous vancomycin and high-dose ciprofloxacin which led to a full recovery. This report highlights the significant risk posed by B. cereus infection in neutropenic patients, the use of 16S rRNA PCR sequencing test for definitive diagnosis and use of combination therapy for successful treatment of B. Cereus CNS infection.

Keywords: 16S rRNA PCR sequencing; AML, Acute Myeloid Leukemia; B. cereus, Bacillus cereus; Bacillus cereus; Brain abscess; CNS infection; CNS, Central Nervous System; CSF, cerebrospinal fluid; CT, computer tomography; Combination antibiotic therapy; IV, intravenous; Immunocompromised; MRI, magnetic resonance imaging; PCR, polymerase chain reaction; rRNA, ribosomal ribonucleic acid.

Publication types

Case Reports