Sepsis Due to Ochrobactrum Anthropi Secondary to Perforated Appendicitis: An Unusual Report in an Immunocompetent Patient

Acute appendicitis is one of the most common causes of inflammatory acute abdomen. In perforated cases, there is increased risk of abdominal sepsis and bacteremia. Ochrobactrum anthropi is an environmental gram-negative bacillus of low virulence, rarely associated with human infection, usually isolated in immunosuppressed patients or those with invasive devices. Its identification in previously healthy patients is uncommon, with few cases in the literature. A 35-year-old previously healthy woman presented with epigastric, pressure-like abdominal pain without radiation after eating ceviche, without fever or bowel habit changes. She received outpatient ciprofloxacin for presumed gastroenteritis. Within 12 hours, she developed migratory pain to the right iliac fossa, nausea, anorexia, and fever. On exam, she had tenderness on deep palpation in the right iliac fossa and a positive Blumberg sign. Abdominal CT showed a fluid-distended appendix, appendicolith, and fat stranding. She underwent urgent appendectomy, and intraoperatively a perforated grade 4 appendicitis with pus in the cavity was found. Metronidazole and ciprofloxacin were started. She evolved with persistent fever, tachycardia, hypotension, leukocytosis, and prolonged INR. Two sets of blood cultures grew O. anthropi susceptible to quinolones. She remained in the ICU with intensive support and showed progressive improvement. This is a rare infection by O. anthropi in an immunocompetent patient, probably related to bacterial translocation secondary to appendiceal perforation. The case underscores the importance of culture and microbiological identification in abdominal sepsis, even in patients without typical risk factors. Early surgical management, targeted antimicrobial therapy, and intensive support were decisive for the favorable outcome.