Infect Chemother.  2015 Jun;47(2):125-128. 10.3947/ic.2015.47.2.125.

Enterobacter cloacae Sacroiliitis with Acute Respiratory Distress Syndrome in an Adolescent

• Kim JS
• Ko JH
• Lee S
• Jeon SC
• Oh SH

• KMID: 2068999
• DOI: http://doi.org/10.3947/ic.2015.47.2.125

Abstract

Enterobacter cloacae has emerged as an important nosocomial pathogen, but is rarely a cause of sacroiliitis. Herein, we present the first reported case of Enterobacter cloacae sacroiliitis associated with sepsis and acute respiratory distress syndrome (ARDS). A previously healthy 14-year-old boy presented with low-grade fever and pain in the left side of the hip that was aggravated by walking. Pelvic computed tomography (CT) showed normal findings, and the patient received supportive care for transient synovitis with no antibiotics. However, there was no clinical improvement. On the third day of hospitalization, magnetic resonance imaging of the hip revealed findings compatible with sacroiliitis, for which vancomycin and ceftriaxone were administered. The patient suddenly developed high fever with dyspnea. Chest radiography and CT findings and a PaO2/FiO2 ratio <200 mmHg were suggestive of ARDS; the patient subsequently received ventilatory support and low-dose methylprednisolone infusions. Within one week, defervescence occurred, and the patient was able to breathe on his own. Following the timely recognition of, and therapeutic challenge to, ARDS, and after 6 weeks of parenteral antimicrobial therapy, the patient was discharged in good health with no complications.

Keyword

Enterobacter cloacae; Sepsis; Sacroiliitis; Acute respiratory distress syndrome; Adolescent

MeSH Terms

Adolescent*
Anti-Bacterial Agents
Ceftriaxone
Dyspnea
Enterobacter cloacae*
Fever
Hip
Hospitalization
Humans
Magnetic Resonance Imaging
Male
Methylprednisolone
Radiography
Respiratory Distress Syndrome, Adult*
Sacroiliitis*
Sepsis
Synovitis
Thorax
Vancomycin
Walking
Anti-Bacterial Agents
Ceftriaxone
Methylprednisolone
Vancomycin

Figure

• 

  Figure 1 Fat-suppressed axial T1-weighted magnetic resonance images of sacroiliac joints showing synovitis and capsulitis of the left sacroiliac joint with extra-articular extension to the left iliacus muscle and iliac vessels on the third hospital day (A) and improvement in the extra-articular soft tissue inflammation but aggravated subchondral inflammation on the 13th hospital day (B) (arrow).

• 

  Figure 2 Chest radiograph on the fourth hospital day showing bilateral lower lobe infiltrates (A). Chest computed tomography images on the third hospital day shows bilateral and symmetric compartmental consolidation in gravity-dependent areas of the lung compatible with acute respiratory distress syndrome (B).

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