Meningitıis Due to Sphingomonas paucimobilis in a Pediatric Patient: A Case Report

Sphingomonas paucimobilis is a gram-negative, nonfermentative, aerobic, oxidase and catalase positive, non-spore producing bacterium characterizied with yellow pigment production and motile with polar flagella. In this study, we describe an unusual case of S. paucimobilis meningitis in a patient with ventriculoperitoneal shunt. A 13-years-old girl was brought to the emergency room with complaints of fever and headache for two days. She had ventriculoperitoneal shunt surgery following posterior fossa tumor surgery 10 years before. Upon physical examination, the patient was uncomfortable and had 39°C body temperature. Laboratory results were as follows: hemoglobin, 12.6 g/dL; leukocyte count, 18,800/mm3 (76% neutrophil); platelet count, 179,000/mm3; and C-reactive protein, 34 mg/dL. The patient was prediagnosed with meningitis and cerebrospinal fluid sample (CSF) was taken before the empirical vancomycin and meropenem treatment. Shunt was removed, CSF was drained externally. The sample was sent to the Microbiology laboratory. CSF sample was inoculated on 5% sheep blood agar and Eosin-Methylene Blue agar. After 24 hours of incubation at 37oC, Gram-negative bacilli were grown on media. The isolate was identified as S. paucimobilis using the VITEK 2 automated system. The bacterium was susceptible to imipenem, colistin, levofloxacin, meropenem and cefepime. The patient was treated successfully with appropriate antibiotic treatment. We describe this unusual case of ventriculoperitoneal shunt infection with S. paucimobilis. In conclusion, S. paucimobilis is an infectious agent that is prevalent in nature but may also be isolated in the hospital setting. It can lead to nosocomial or community acquired infections. Although it can be eliminated with prophylactic therapy, sensitivity pattern should be definitely studied to determine the optimal treatment.