Sphingomonas paucimobilis infection in subcutaneous abdominal preservation of bone flap after craniotomy

Introduction: Sphingomonas paucimobilis, previously known as Pseudomonas paucimobilis, is a Gram-negative rod. It is emerging as an opportunistic pathogen that can infect individuals in community or hospital settings. It is believed that the natural habitat of this organism is soil and water, including water sources in the hospital environment. Case report: We describe the case of a 46-year-old patient in whom S. paucimobilis was identified in the implanted bone flap after craniotomy. The postoperative bone flap was implanted in the right hypochondria and replaced after 8 weeks. There was a hypochondriac abscess in the area under the bone. Specimens from the thickened fascia and bone flap were cultured. The Gram stain showed Gram-negative rods and these rods were identified as S. paucimobilis. The patient was treated with a combination of Gentamicin 240 mg and Levofloxacin 750 mg once daily because the bacteria were resistant to carbapenem, trimethoprim-sulfamethoxazole, and anti-pseudomonal penicillin. Conclusions: Although S. paucimobilis characteristically presents low virulence, for better patient management and outcome, the diagnosis should be immediately followed by appropriate antibiotic therapy guided by susceptibility test results of each case.