Metachronous cellulitis caused by rare nonfermentative Gram-negative bacilli, Sphingobacterium and Myroides species: A case report and literature review

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Cellulitis is one of the most common forms of skin and soft tissue infections, traditionally attributed to beta-hemolytic streptococci and Staphylococcus aureus. While Gram-negative organisms, particularly nonfermentative gram-negative bacilli (NFGNB), are ubiquitous in soil and aquatic ecosystems, they are rarely reported as causative pathogens of cellulitis. We report a case of metachronous cellulitis caused by two species of NFGNB: Sphingobacterium and Myroides species. An 81-year-old male was admitted with cellulitis of the left upper extremity. Sphingobacterium species was identified from blood cultures using Oxford Nanopore Technologies MinION sequencer. The patient was treated with antibiotics and recovered. Eleven months later, the patient was readmitted with similar symptoms of cellulitis in the left upper extremity. Myroides species was identified from blood cultures using MinION sequencer and Matrix-Assisted Laser Desorption/Ionization Time-of-Flight Mass-Spectrometry. The occurrence of cellulitis caused by NFGNB is rare, and this case is unique because two different NFGNB species caused cellulitis at separate time points.