A Case of Community-Acquired Pneumonia Due to Elizabethkingia Meningoseptica

Elizabethkingia meningoseptica has been considered a rare nosocomial cause of pneumonia, especially in the adult population. Risk factors include immunosuppression, recent hospitalizations, and procedures. We present a rare case of community-acquired Elizabethkingia meningoseptica pneumonia (CAP) in an adult without risk factors. 57-year-old Male, past medical history of hypertension & a solitary kidney presented with one week of generalized weakness, 30-lb weight-loss, productive cough & intermittent fevers. He had no history of malignancy, recent travel, sick contacts nor exposure to pools, bodies of water or fish. He denied any history of lung disease nor tobacco, alcohol, or illicit drug use. Laboratory studies revealed leukocytosis with neutrophilic predominance, lactic acidosis, non-reactive HIV and negative COVID-19 tests. Chest radiograph revealed right apical lung consolidation;computed tomography of the chest revealed a patchy ground-glass opacity in the right upper lobe (RUL). On examination he was found to have diffuse inspiratory and expiratory wheezing and productive cough. The patient was admitted for treatment of CAP with hyperreactive airways. In the ER, the patient was empirically started on methylprednisolone, ceftriaxone and azithromycin. He subsequently underwent a bronchoscopy with washing, protected & cytology brushings of the RUL that revealed multidrug-resistant Elizabethkingia meningoseptica, susceptible to ciprofloxacin and sulfamethoxazole/trimethoprim. Patient was transitioned to ciprofloxacin with improvement of his clinical status as well as the RUL opacity. This case highlights several important factors. First, it allows further investigation on Elizabethkingia meningoseptica, a rare gram-negative, rarely infectious, aerobic bacillus prevalent in natural water sources & soil. Incidence of 5-10 cases per state per year in the US;involving pediatric bacteremia & meningitis, in immunocompromised states (cystic fibrosis). However, it is rarely a cause of CAP or nosocomial pneumonia in adults. This microbe is associated with the intensive care unit (ICU), including mechanical ventilation, insertion of invasive lines/devices, and immunocompromised states. Interestingly, exposure to water sources within hospitals, including bronchoscopy, can be a source. However, our patient presented with clearly defined pneumonia, then had a bronchoscopy. Second, we learn the multidrug resistance of this pathogen (β-lactams, aminoglycosides, carbapenems), and the sensitivities (fluoroquinolones and sulfamethoxazole/trimethoprim) lending to a difficult eradication. Third, CAP from Elizabethkingia meningoseptica highlights the importance of identifying various risk factors for the development of pneumonia. By shedding light to this pathogen, we hope to further improve the identification and treatment of CAP secondary to Elizabethkingia meningoseptica.