Williamsia serinedens has been isolated from soil but has not yet been implicated in human disease. We report the first case of perinatal sepsis caused by a dual-morphotype form of Williamsia serinedens in a 31-year-old pregnant woman hospitalized with preterm labor.
CASE REPORTA 31-year-old woman who was 23 weeks pregnant was admitted to our hospital for management of preterm labor in the setting of cervical insufficiency and twin gestation. She had originally presented to her obstetrician 1 week earlier for routine prenatal care, at which time she was found to have cervical dilation at 5 cm. At the time of admission, the patient was asymptomatic with normal vital signs and unremarkable physical examination. Pelvic ultrasonography revealed a shortened cervix and twin fetuses with normal heart tones, motion, and size. The patient was started on tocolytic therapy utilizing indomethacin and magnesium sulfate, as well as ceftazidime for empirical management of chorioamnionitis.Eight weeks into her hospitalization, the patient reported generalized myalgias and malaise, although no fever was documented initially. After routine hematology revealed a leukocyte (WBC) count of 9,900 WBCs/mm 3 with 34% band forms, an amniocentesis was performed, revealing only 22 WBCs/ mm 3 (reference range, Ͻ30 WBCs/mm 3 ) with culture yielding no growth. Empirical meropenem was initiated, and two sets of blood cultures collected 25 h apart, one from her percutaneously inserted central catheter (PICC) and the other from venipuncture, yielded aerobic, Gram-positive bacilli which could not be identified by our laboratory. The patient's antibiotic therapy was then changed to ampicillin and vancomycin, her PICC line was removed, and the tip was cultured, yielding no growth.Despite empirical therapy, the patient's clinical course worsened with the development of headache, fever, hypotension, and persistence of left shift. After a lumbar puncture revealed only 1 WBC/mm 3 (reference range, Ͻ4 WBC/mm 3 ), cesarean delivery was performed at 32 weeks gestation with successful delivery of twins. The twins had identical Apgar scores of 7 and 9. Placental pathology revealed mild villous edema but no structural anomaly or inflammation. The patient improved thereafter with resolution of fever and sterilization of blood cultures. She completed a 2-week course of intravenous vancomycin and oral ampicillin. Blood cultures collected from each of her neonates on the day of delivery yielded no growth. As of this submission, both she and her infants have recovered and are healthy.The isolate was transferred from our laboratory to the Tennessee Department of Health laboratory, where it was identified as an aerobic actinomycete. Morphologically, it was observed as a pleomorphic Gram-positive, non-acid-fast coccobacillus, whose macrocolonies on brain heart infusion (BHI) agar at 4 to 7 days growth were orange, of soft texture, and with mycelial edges. It was submitted to the Centers for Disease Control and Prevention actinomycete reference laboratory, where it w...