Tsukamurella pulmonis bacteremia in a young patient with epidermolysis bullosa: A case report

Abstract Tsukamurella species are rare, aerobic, gram-positive actinomycetes that are increasingly recognized as opportunistic pathogens affecting immunocompromised patients, such as those suffering from epidermolysis bullosa. Epidermolysis bullosa is a rare genetic disorder characterized by skin fragility that predisposes patients to chronic wounds and recurrent skin infections. The case of interest in this work was a 22-year-old male with a complex medical history, including the aforementioned disorder. He was admitted to the hospital’s emergency department, presenting with fluctuating low-grade fever and recurrent bleeding of the skin lesion on his flank. Infectious workup was sent, after which appropriate intravenous fluids were administered for resuscitation, along with broad-spectrum antibiotics. During the patient’s hospitalization, he was found to have Tsukamurella pulmonis and methicillin-resistant Staphylococcus aureus bacteremia, which was treated with vancomycin administered intravenously. Treatment resulted in significant improvement. This case adds to the limited body of studies describing T. pulmonis as a human pathogen. It highlights the importance of considering such rare opportunistic infectious agents in immunocompromised patients with chronic wounds and indwelling catheters. The study serves as a reference for clinicians, emphasizes the therapeutic challenges encountered in managing this infection in high-risk populations, and sheds the light on the need for established policies and clinical guidelines.