We present the first case of Sphingomonas paucimobilis otomastoiditis, complicated with subperiosteal abscess in an immunocompetent child.
Case Report A 11-year-old boy with previous diagnosis of chronic bilateral otitis media presented with 20 days of fever, otalgia, otorrhea, progressive retroauricular swelling with protrusion of the left ear and worsening of the symptoms despite 15 days of Amoxicilin. A CT scan was performed (Figure 1). Blood tests showed WBC 22,4 × 109 (neutrophils 81,2%) and CRP of 142. Surgical drainage of the abscess found a large amount of purulent foetid secretion. We empirically initiated Ceftazidime and Clindamycin. He remained well, with defervescence and resolution of the scalp deformation. Control test showed WBC 7,4 × 109 (neutrophils 58,7%) and CRP of 6. Culture of the abscess grew Sphingomonas paucimobilis. The patient was discharged with Cyprofloxacin and returned after 1 month in our clinic recovered.
Discussion S. paucimobilis is an aerobic gram-negative bacillus that rarely infects humans, most commonly immunocompromised and hospitalised patients. We searched the literature for S. Paucimobilis infections in children and found 47 reported cases (Table 1). The most common diagnosis is isolated bacteremia and there are no previous report of otomastoiditis. It is related to sporadic or epidemic infections, leading to just one published case of death in children. S. paucimobilis infection has been increasingly reported over the years and it’s a more important pathogen than previously thought.