A rare case of pneumonia caused by Achromobacter Denitrificans concomitant with pulmonary embolism after gastrectomy for gastric cancer

Abstract

This was a 77-year-old female patient and admitted due to "upper abdominal pain for about 20 days". After six days, the patient received radical total gastrectomy and was dignosed as gastric cardia adenocarcinoma stage II B (T3N1M0). Sixth days after the operation, an emergency laparotomy was performed because of postoperative abdominal bleeding. Just after that, the patient got pneumonia and then was switched to ICU. After improvement she was discharged. The patient was referred to our hospital again with pneumonia one month later. CTPA showed bilateral pulmonary embolism. Then the patient was treated with intra-arterial thrombolysis, enoxaparin and warfarin separately. However, cough, expectoration and dyspnea did not improve. After another month, Achromobacter denitrificans (A. denitrificans) were detected from sputum and bronchoalveolar lavage fluid. Then the patient was started with regimen as follows: diluted Amikacin 0.2g injected locally once, meropenem 1g i.v. q8h for two weeks firstly and piperacillin /tazobactam 4.5g i.v. q8h for the following two weeks. The patient got a full recoverment finally. There are two specials in this case of postoperative pulmonary infection. First, this is an infectious disease with specific pathogenic bacteria-A. denitrificans. There are few records about the pulmonary infection of A. denitrificans. Especially, it was the first report of a case without underlying lung diseases. Second, this special pneumonia came along with pulmonary embolism and gastric cancer. Even though a case was mentioned of thrombophlebitis complicated with osteomyelitis after traumatic Achromobacter xylosoxidans, it is still unclear whether or not the correlation exists. Further study is required to determine if A. denitrificans easily promote thrombosis and if gastric cancer is a main cause of pulmonary embolisms.