A Rare Case of Pantoea Agglomerans Causing Haematuria and Urethritis in a Patient with Acute Myeloid Leukaemia (AML)

Pantoea agglomerans, a Gram negative bacterium of the family, Enterobacteriaceae, has been reported to cause septic arthritis/synovitis, endophthalmitis, periostitis, endocarditis, osteomyelitis, cholelithiasis, peritonitis and skin allergy [1-6]. We report the first case of haematuria with pantoea urethritis in a 51 year old adult male who was undergoing chemotherapy for acute myeloid leukaemia on the AML 19 trial. He developed a persistent fever with haematuria five days after completion of chemotherapy. The blood culture from his PICC line grew pantoea agglomerans sensitive to ceftriaxone. He became neutropenic with associated fevers post chemotherapy, so he was started empirically on meropenem and vancomycin as per the neutropenic sepsis policy. He continued these for eight days until blood culture results were available. Although urine culture was negative, CT Urogram however revealed features consistent with urethritis. He completed another week of intravenous ceftriaxone and haematuria subsequently resolved. It is very likely that pantoea agglomerans caused the urethritis which resolved with antibiotics and repeat blood cultures returned negative. Pantoea agglomerans commonly occurs in plants as an epi or endophytic symbiont [7] with reports of opportunistic infection mostly in immunocompromised individuals. 6 Most human infections reportedly occur through skin breaks for instance through thorn pricks [2,4,6] during gardening, although there are also reports of sepsis through contaminated parenteral fluids [1,2] and indwelling lines/ catheters [8] or even presenting like a tumour [9]. Timely antibiotics intervention led to the favourable outcome in our case. Mortality with pantoea agglomerans infection has been reported especially in immunocompromised children, [10] our case of pantoea agglomerans urethritis was most likely line associated. The case highlights the importance of developing policies on performing investigations on immunocompromised patients including those at risk of neutropenic sepsis with timely intervention and targeted antibiotics to give the best possible outcome and patient care.