A possible Sphingomonas paucimobilis endocarditis in a haemodialysed patient: A case report

Sphingomonas paucimobilis is widely distributed in the environment and causes occasional human infections, most often in immunocompromised individuals. Reports of unusual invasive and severe infections include septic arthritis, osteomyelitis, respiratory tract infections in patients with cystic fibrosis and necrotising soft tissue infections. There are only few reported cases of endocarditis in the international literature. There are no published cases in Sri Lanka.We describe a possible case of Sphingomonas paucimobilis endocarditis. A 58 year old male patient presented with reduced responsiveness following haemodialysis. All three blood cultures taken on admission were positive for Sphingomonas paucimobilis. His echocardiography could not exclude endocarditis. He was treated with appropriate antibiotics but unfortunately expired due to septic shock following aspiration pneumonia. This case demonstrates that organisms of low virulence could cause endocarditis in patients with end stage renal disease. It also indicates that such patients are relatively asymptomatic or have few symptoms compared to patients with normal immunity.