Abstract
INTRODUCTION AND IMPORTANCE: Achromobacter xylosoxidans is a gram-negative bacillus typically found in the respiratory tracts of cystic fibrosis patients. While it is a known pathogen in respiratory infections, it infrequently causes skin and soft tissue infections (SSTIs). This case represents the first documented instance of A. xylosoxidans causing an SSTI in the USA to the best of our knowledge. CASE PRESENTATION: A 25-year-old male with X-linked agammaglobulinemia (BTK mutation) presented with 4 days of progressive left leg pain, swelling, and erythema. Blood cultures grew A. xylosoxidans, and the patient was diagnosed with cellulitis and bacteremia. He was initially treated with piperacillin/tazobactamand received a dose of intravenous immunoglobulin. Trimethoprim/sulfamethoxazole was prescribed upon discharge. The patient showed clinical improvement, with resolution of symptoms at follow-up. CLINICAL DISCUSSION: Although rare, A. xylosoxidans infection should be considered a potential cause of SSTI-related bacteremia in immunocompromised patients. Initial empiric broad spectrum followed by de-escalation based on culture and susceptibility test is recommended. CONCLUSION: Clinicians must be aware of A. xylosoxidans as a potential pathogen in SSTIs, especially in immunocompromised patients.