An 85-year-old Spanish female was admitted to our hospital in March 2015, after she had experienced five days with a cough, hemoptoic sputum, dyspnea, and a fever. She had no known toxic habits or surgical background. She was diagnosed with tuberculosis when she was a child, and in 2009, Mycobacterium fortuitum was isolated in a sputum culture for which she received treatment with Isoniazid, Rifampin, and Pyrazinamide. She was diagnosed with Diffuse Large B Cell Non-Hodgkin Lymphoma (stage 1A) in 2007 and received treatment with Rituximab and complementary radiotherapy with a favorable response. She was also diagnosed with cryoglobulinemic vasculitis in 1999 and was on corticosteroid treatment at the time.
Clinical findings were as follows: body temperature 36.2 C, blood pressure 96/60 mmHg, heart rate 160 beats/min, respiratory rate 30 breaths/min, and oxygen saturation 88% (room air). The physical examination revealed a disseminated petechial rash over her body; pulmonary auscultation showed diffuse rhonchi and diminished respiratory sounds at the left lung base. Laboratory tests revealed the following: 11.7 g hemoglobin; white blood cell count 5,000 x 109/L with 90% neutrophils; C-reactive protein level 4.0 mg/dL; procalcitonin level 1.06 mug/L; and the platelet count, arterial blood clotting, and the rest of the biochemical tests were within normal ranges.
The chest X-ray revealed a left lung basal infiltrate (Figure 1). All three blood cultures obtained on admission showed Moraxella catarrhalis growth, which was B-lactamase-positive and susceptible to Ceftriaxone, Azithromycin, and Levofloxacin. Sputum cultures were negative, and a chest X-ray was performed during her hospitalization showing radiological improvement. The patient was treated with Levofloxacin for two weeks with clinical improvement and was discharged. She suffered a left femur fracture three months later and died during her hospitalization.