Successful treatment of pulmonary haemorrhage and acute respiratory distress syndrome caused by fulminant Stenotrophomonas maltophilia respiratory infection in a patient with acute lymphoblastic leukaemia – case report

Abstract

Background Stenotrophomonas maltophilia-induced pulmonary haemorrhage is considered a fatal infection among haematological patients. The outcome can be explained by the patients’ immunity status and late diagnosis and treatment. Case presentation We present the rare case of successful outcome in a 61-year-old female who developed alveolar haemorrhage and acute respiratory distress syndrome 8 days after a chemotherapy session for her acute lymphoblastic leukaemia, in the context of secondary bone marrow aplasia. Stenotrophomonas maltophilia was isolated in sputum culture. The patient benefitted from early empirical treatment with colistin followed by trimethoprim/sulfamethoxazole, according to the antibiogram. Despite a severe initial clinical presentation in need of mechanical ventilation, neuromuscular blocking agents infusion, and ventilation in prone position, the patient had a favourable outcome and was discharged from intensive care after 26 days. Conclusions Stenotrophomonas maltophilia severe pneumonia complicated with pulmonary haemorrhage is not always fatal in haematological patients. Empirical treatment of multidrug-resistant Stenotrophomonas maltophilia in an immunocompromised haematological patient presenting with hemoptysis should be taken into consideration.

Combination Therapy versus Monotherapy in the Treatment of Stenotrophomonas maltophilia Infections: A Systematic Review and Meta-Analysis

“…Of the 28 articles, 11 were excluded due to inappropriate comparisons ( n = 4), in vitro studies ( n = 5), editorial ( n = 1), and no response from author for incomplete data ( n = 1). A total of 17 studies, published between 1996 and 2022, comprised of case reports ( n = 9), case series ( n = 4), and cohort studies ( n = 4) [ 10 , 11 , 12 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 ] were included in the review. Details of the included studies’ case reports/case series are summarized in Table 1 and Supplementary Table S3 , and four cohort studies [ 25 , 26 , 27 , 28 ] are summarized in Table 2 and Supplementary Table S4 .…”

Hemorrhagic Pneumonia Caused by Stenotrophomonas maltophilia in Patients with Hematologic Malignancies—A Systematic Review and Meta-Analysis

“…In the literature, we discovered a total of 93 instances of hemorrhagic pneumonia caused by Stenotrophomonas maltophilia, including two cases involving newborns [20] and 91 cases with hematologic malignancies (Table 1) [21][22][23][24][25][26][27][28][29][30][31][32][33][34][35][36][37][38][39]. Table 2 provides a summary of the extensive clinical data for the 91 patients.…”

“…Nine survival cases have been reported in the literature. A 61-year-old female acute lymphoblastic leukemia patient with alveolar hemorrhage, acute respiratory distress syndrome, and Stenotrophomonas maltophilia isolation from sputum culture was presented by Andrei, S. et al After receiving therapy with colistin and trimethoprim-sulfamethoxazole (TMP-SMX) and seeing a recovery of pneumonia, the patient had a positive outcome and was released from critical care after 26 days [35]. Penagos, S.C. et al reported that the early use of combination therapy with TMP/SMX, polymyxin, and/or moxifloxacin resulted in good treatment results for two hematologic malignancy patients with hemorrhagic pneumonia caused by Stenotrophomonas maltophilia.…”

“…Penagos's trial reported on two patients who were effectively treated following early combination treatment with TMP/SMX, polymyxin, and/or moxifloxacin [34]. Additionally, Andrei, S. et al reported that hemorrhagic pneumonia resolved after treatment with colistin and TMP/SMX [35]. From the experience of the aforementioned seven successful instances, the preferred second medications may include polymyxin, colistin, and moxifloxacin.…”