Introduction: Myroides spp. are yellow-pigmented, opportunistic gram-negative bacteria. Very few cases have been reported, but the incidence has been increasing over the past years. They were primarily associated from clinical sources; however, a number of studies have indicated that they are widely available in the aquatic environment. These infections pose a challenge when it comes to treating them, because it produces a biofilm that makes it resistant to multiple antibiotics. We present a rare case of Myroides odoratimimus blood stream infection in a patient presenting with encephalopathy and short-term memory loss.

Case Presentation: A 65-year-old male with a PMH of type 2 diabetes mellitus and CHF presented to the ED after being found at home with altered mental status. He was found in the floor covered in human feces, maggots and flies. He was last seen 4 days ago while walking his dog. The last event he remembered occurred 8 days prior to admission and he had no recollection of the events that happened in the last 4 days. Vitals were stable except for moderate hypothermia at 29.8 C. Laboratory tests showed profound acidosis, rhabdomyolysis and acute kidney injury. CT scan of the head and C-spine were negative for acute pathology. Upon physical examination, he had retiform purpura with cutaneous necrosis formation over his chest and legs. Blood and tissue cultures were collected. Due to the perplexing skin lesions and his immunocompromised state, the differentials included, but were not limited to vasculitis, invasive mucormycosis, anticoagulation-induced necrosis, fungal/bacterial sepsis and embolic event. Due to concerns for angioinvasion, he was started on Vancomycin, Cefepime and Flagyl. He was given IV fluid resuscitation, bicarbonate and placed on bair hugger for hypothermia.

Final diagnosis: Blood cultures grew Myroides odoratimimus. Tissue cultures were positive for Enterobacter cloacae, Candida parapsilosis and Staphylococcus saprophyticus.

Management/Follow-up: When culture sensitivities came back, he was transitioned to Ciprofloxacin and completed a 10-day course of antibiotics. He was able to recover successfully and repeat blood cultures showed resolution of the infection. Even at the time of discharge, he still was not able to recall the events that led to his hospitalization.

References

Benedetti, P., Rassu, M., Pavan, G., et al., 2011. Septic shock, pneumonia, and soft tissue infection due to Myroides odoratimimus: report of a case and review of Myroides infections. Infection, 39(2): 161–165. http://dx.doi.org/10.1007/s15010-010-0077-1

Hu, Sh., Yuan, Sx., Qu, H. et al. Antibiotic resistance mechanisms of Myroides sp.. J. Zhejiang Univ. Sci. B 17, 188–199 (2016). https://doi.org/10.1631/jzus.B1500068

Tiana R. Endicott-Yazdani, Neelam Dhiman, Raul Benavides & Cedric W. Spak (2015) Myroides Odoratimimus Bacteremia in a Diabetic Patient, Baylor University Medical Center Proceedings, 28:3, 342-343, DOI: 10.1080/08998280.2015.11929268