Extracorporeal membrane oxygenation in Stenotrophomonas maltophilia pneumonia during acute myeloid leukemia: A case report

Kenki Saito; Toshiyuki Aokage; Takayuki Sato; Kohei Tsukahara; Fumiaki Tokioka; Takanao Otake; Hiromasa Irie; Yasunori Ueda

doi:10.1016/j.rmcr.2020.101224

Extracorporeal membrane oxygenation in Stenotrophomonas maltophilia pneumonia during acute myeloid leukemia: A case report

Respir Med Case Rep. 2020 Sep 14:31:101224. doi: 10.1016/j.rmcr.2020.101224. eCollection 2020.

Authors

Kenki Saito¹, Toshiyuki Aokage², Takayuki Sato¹, Kohei Tsukahara³, Fumiaki Tokioka⁴, Takanao Otake⁵, Hiromasa Irie⁵, Yasunori Ueda¹

Affiliations

¹ Department of Hematology/Oncology, Kurashiki Central Hospital, Japan.
² Department of Geriatric Emergency Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan.
³ Department of Emergency, Critical Care and Disaster Medicine, Okayama University Hospital, Okayama, Japan.
⁴ Department of Respiratory Medicine, Kurashiki Central Hospital, Kurashiki, Japan.
⁵ Department of Anesthesiology, Kurashiki Central Hospital, Kurashiki, Japan.

Abstract

Stenotrophomonas maltophilia (S. maltophilia) is a Gram-negative, multidrug-resistant organism that both opportunistically infects the bloodstream and leads to pneumonia in immunosuppressed patients, including those with hematologic malignancies. In patients with severe respiratory failure, venovenous extracorporeal membrane oxygenation (VV ECMO) can stabilize the respiratory status. However, whether ECMO in patients with hematologic malignancies improves the clinical outcomes is still controversial because ECMO increases the risk of the exacerbation of sepsis and bleeding. We report a case of a 46-year-old man with Stenotrophomonas maltophilia hemorrhagic pneumonia acquired during consolidation chemotherapy for acute myeloid leukemia in whom VV ECMO lead to a good clinical outcome. The stabilization of his respiratory status achieved with VV ECMO allowed time for trimethoprim-sulfamethoxazole antibiotic therapy to improve the pneumonia. We suggest the background of patients, including comorbidities and general conditions, should be taken into account when considering the clinical indications of ECMO.

Keywords: Acute myeloid leukemia; Acute panmyelosis with myelofibrosis; Extracorporeal membrane oxygenation; Severe pneumonia; Stenotrophomonas maltophilia.

Publication types

Case Reports