Sphingomonas paucimobilis - A Rare Cause of Community-Acquired Pneumonia

Nonresolving pneumonia (NRP) is a common diagnostic challenge encountered in daily practice. Sphingomonas paucimobilis grows easily in hospital equipment. However, it is also an emerging pathogen and not just a contaminant of hospital setup. Most of the S. paucimobilis infections reported in the literature have been health care associated, but contrary to the recent publications, we revealed a community-acquired infection. Due to its low virulent features of bacteria, it is not associated with serious life-threatening infections, but with increasing number of case reports, it should be considered as an important pathogen in NRP. We report a case of a 35-year-old female presenting with? Nonresolving pneumonia c/o cough with expectoration for 10 months and low-grade fever for 2 months. She had received multiple courses of antibiotics including intravenous beta-lactams and macrolide. Her blood investigations were normal. Her sputum? dsAFB was negative. Her initial chest X-ray (CXR) was suggestive of bilateral lower zone consolidation. Computed tomography thorax was suggestive of right middle lobe and left lingular lobe consolidation. Bronchoscopy was normal except for pus flakes seen in the left lingular lobe. Reports of BAL were negative for dsAFB, AFB?CBNAAT, and malignant cells. Culture and sensitivity report was suggestive of growth of S. paucimobilis sensitive to meropenem, third-generation cephalosporins, fluoroquinolones, and aminoglycosides. The patient was started on meropenem and amikacin for 10 days, and the patient's repeat CXR showing a significant resolution was hence discharged on levofloxacin for 7 days.