Acho, Robert J

Aravapally, Amitha

Basal, Yasmeen

Faraj, Usama

Oommen, Jerry

English

Henry Ford Health System Scholarly Commons

Henry Ford Health Henry Ford Health Scholarly Commons Internal Medicine Articles Internal Medicine 5-1-2021 Facklamia hominis in hidradenitis suppurativa Yasmeen Basal Jerry Oommen Usama Faraj Robert J. Acho Henry Ford Health, racho1@hfhs.org Amitha Aravapally Henry Ford Health, aaravap1@hfhs.org Follow this and additional works at: https://scholarlycommons.henryford.com/internalmedicine_articles Recommended Citation Basal Y, Oommen J, Faraj U, Acho R, and Aravapally A. Facklamia hominis in hidradenitis suppurativa. JAAD Case Reports 2021; 11:20-22. This Article is brought to you for free and open access by the Internal Medicine at Henry Ford Health Scholarly Commons. It has been accepted for inclusion in Internal Medicine Articles by an authorized administrator of Henry Ford Health Scholarly Commons. CASE REPORTFacklamia hominis inhidradenitis suppurativaYasmeen Basal, DO,a Jerry Oommen, DO,a Usama Faraj, DO,a Robert Acho, DO,b and Amitha Aravapally, MDcEast Lansing and Clinton Township, MichiganKey words: case report; Facklamia hominis; hidradenitis suppurativa; infectious disease.INTRODUCTIONHidradenitis suppurativa (HS) is a chronic, in-flammatory skin condition presenting with recurrent,painful abscesses with malodorous drainage second-ary to follicular occlusion of pilosebaceous units.1Factors contributing to the development of HSinclude genetic predisposition, smoking, hyperan-drogenemia, and bacterial infection. The most com-mon pathogens involved are Staphylococcuslugdunensis and anaerobic actinomycetes1; howev-er, here we present a rare case of HS containingFacklamia hominis. First discovered in 1997, F.hominis is an anaerobic bacterium infrequentlyfound in clinical settings. Facklamia hominis ismost often found in women, suggesting it may bepart of the normal vaginal flora; however, thisspecies has been found in many other sites,including the gastrointestinal intestinal tract, bone,and cerebrospinal fluid.2CASE REPORTA 64-year-old female presented to the emergencydepartment with a left-axillary abscess at the apex ofthe axilla. Her past medical history was significant forpoorly controlled type 2 diabetes mellitus, coronaryartery disease, Hurley stage III HS (the patient did notreceive immunosuppressants due to poor compli-ance and follow-up), and daily tobacco use. Theabscess had been present for about 2 weeks andworsened over the past few days. The patient deniedfevers or chills. Patient vitals during the emergencydepartment visit were within the normal ranges.General surgery was consulted, and performedbedside incision and drainage, obtained gram stainand culture from the axillary abscess, and recom-mended discharge with a 7-day course of peroral(PO) trimethoprim-sulfamethoxazole (TMP-SMX)and outpatient follow-up. However, the patientreturned to the emergency department 5 days laterwith increased pain; malodorous, brown-coloreddischarge, and spread of the abscess within theaxilla. The patient’s vitals and basic lab work wereunremarkable; however, her glucose level waselevated at 386 mg/dL. Blood cultures were alsoobtained, and bedside incision and drainage wasperformed. The previous wound culture demon-strated the presence of Facklamia hominis.Susceptibility was not performed because break-points were not set due to the infrequent observationof this bacterium in clinical settings. Therefore, dueto the failed trial of TMP-SMX, the patient was startedon broad-spectrum intravenous (IV) vancomycinand piperacillin/tazobactam and admitted for furtherevaluation by an infectious disease specialist. Afterevaluation, antibiotic therapy was modified to IVvancomycin and oral moxifloxacin. Over her 3-dayadmission, the patient remained stable with im-provements in terms of tenderness, erythema, indu-ration, and drainage of the wound, and bloodcultures were negative. The patient was dischargedon moxifloxacin 400 mg daily and amoxicillin 1 gevery 8 hours for 7 days with outpatient infectiousdisease follow-up. Although the patient showedAbbreviations used:HS: hidradenitis suppurativaIV: intravenousMALDI-TOF: matrix-assisted laser desorptionionizationetime-of-flight massspectrometryPO: peroralTMP-SMX: trimethoprim-sulfamethoxazoleFrom the Michigan State University College of OsteopathicMedicinea; Department of General Surgeryb and Departmentof Internal Medicinec Henry Ford Macomb Hospital.Funding sources: None.Correspondence to: Yasmeen Basal, DO, 15855 19 Mile Rd, ClintonTownship, MI 48038. E-mail: basalyas@msu.edu.JAAD Case Reports 2021;11:20-2.2352-5126Published by Elsevier on behalf of the American Academy ofDermatology, Inc. This is an open access article under the CCBY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).https://doi.org/10.1016/j.jdcr.2021.03.01720improvement during hospital stay, no documenta-tion of follow-up with infectious disease or surgery isavailable.DISCUSSIONTo our knowledge, only 7 clinical cases involvingFacklamia hominis have been documented(Table I).3-9 Little is known about its pathogenicity,and there is a possibility that F. hominis could be acontaminant in our study. However, this is less likelydue to the fact that it was the only bacterial speciesgrown in culture and due to the failed response toinitial TMP-SMX therapy, which would have eradi-cated common bacteria found in HS-associatedabscesses. As many rapid identification systems donot include this organism in their database, multiplemethods have been used to identify F. hominis. A2013 study found that matrix-assisted laser desorp-tion ionizationetime-of-flight (MALDI-TOF) wasuseful in identifying uncommon bacterial species.10MALDI-TOF was used successfully to identify F.hominis in the present case as well as in others.7,8Although there is no standardized method of iden-tification for F. hominis, physicians should be awareof this method for potential use when this pathogenis suspected.Proper treatment of F. hominis has also provedto be challenging for physicians. A variety ofantibiotics have been used as treatment, includingpenicillins and third-generation cephalosporins(Table I). In this case, the patient was initially givenPO TMP-SMX after incision and drainage, but it wasunsuccessful; eradication was achieved with sub-sequent treatment with IV vancomycin and moxi-floxacin. The key discussion point here is the failureof treatment. TMP-SMX was initiated prior toobtaining culture results for potential methicillinresistant Staphylococcus aureus coverage. Cultureresults however demonstrated the presence of F.hominis, which has shown responsiveness to cef-triaxone, amoxicillin, and ampicillin, but resistanceto TMP-SMX.2,3,5,6,8,9 Given the variable response totherapy, future studies pertaining to susceptibilityare necessary in order to standardize treatment ofcare and avoid antimicrobial resistance.CONCLUSIONThis is a rare case of Facklamia hominis in apatient with HS. Although this pathogen is relativelyuncommon in clinical settings, its increasing preva-lencewithin the past few years necessitates a need forstandardized identification and treatment. Physicianawareness in conjunction with basic science researchis vital to ensure proper care for every patient.Conflicts of interestNone declared.Table I. Previous cases of Facklamia hominis with information on method of identification and treatmentYear Sex Age Source Diagnosis Identification Treatment Reference2005 F 34 yrs Blood Chorioamnionitis unknown Penicillin andampicillin32010 unknown unknown Blood Endocarditis VITEK 2 system Gentamicin andVancomycin*42012 M 35 yrs Blood Endocarditis unknown IV Ceftriaxone 52014 F 81 yrs Periprosthetic femoraltissue, femoralinterfacemembrane,acetabular interfacemembraneProsthetic hipjoint infectionVITEK 2 systemand confirmedby 16S rRNAgeneamplification6 weeks of IVceftriaxonefollowed by6 weeks ofampicillin PO62016 F 40 yrs Abscess exudate Scapular abscess MALDI-TOF Pristinamyciney 72019 M 9 yrs Penile exudate Balanoposthitis Massspectrometry,MALDI-TOFamoxicillin-clavulanicacid PO82019 M 75 yrs Urine Urosepsis Gene sequencingusing RAST andProkka withphenotyperesistanceassessed by MICAmpicillin-sulbactamand vancomycin9M, Male; F, female; IV, intravenous; MIC, minimal inhibitory concentration; PO, peroral; RAST, radioallergosorbent test; yrs, years old.*Treatment was unsuccessful in eradicating bacteria.yUnknown if treatment was successful in eradicating bacteria.JAAD CASE REPORTSVOLUME 11Basal et al 21REFERENCES1. Vossen ARJV, van der Zee HH, Prens EP. Hidradenitis suppu-rativa: a systematic review integrating inflammatory pathwaysinto a cohesive pathogenic model. Front Immunol. 2018;9:2965.2. LaClaire L, Facklam R. Antimicrobial susceptibilities and clinicalsources of Facklamia species. Antimicrob Agents Chemother.2000;44(8):2130-2132.3. Healy B, Beukenholt RW, Tuthill D, Ribeiro CD. Facklamiahominis causing chorioamnionitis and puerperal bacteraemia.J Infect. 2005;50(4):353-355.4. Safavi S, Tufnell M, Bhalla A. Multi-territory ischaemic strokesand subacute bacterial endocarditis. BMJ Case Rep. 2010;2010:bcr0620092023.5. Ananthakrishna R, Shankarappa RK, Jagadeesan N, Math RS,Karur S, Nanjappa MC. Infective endocarditis: a rare organismin an uncommon setting. Case Rep Infect Dis. 2012;2012:307852.6. Corona PS, Haddad S, Andres J, Gonzalez-Lopez JJ, Amat C,Flores X. Case report: first report of a prosthetic joint infectioncaused by Facklamia hominis. Diagn Microbiol Infect Dis. 2014;80(4):338-340.7. Abat C, Garcia V, Rolain JM. Facklamia hominis scapula abscess,Marseille, France. New Microbes New Infect. 2015;9:13-14.8. Gomez-Luque JM, Foronda-Garcıa-Hidalgo C, Gutierrez-Fernandez J. Balanopostitis by Facklamia hominis in pediatrics.Rev Esp Quimioter. 2019;32(3):278-280.9. Mostafa HH, Taffner SM, Wang J, Malek A, Hardy DJ,Pecora ND. Genome sequence of a Facklamia hominis isolatefrom a patient with urosepsis. Microbiol Resour Announc. 2019;8(17):e00100-e00119.10. Seng P, Abat C, Rolain JM, et al. Identification of rarepathogenic bacteria in a clinical microbiology laboratory:impact of matrix-assisted laser desorption ionization-time offlight mass spectrometry. J Clin Microbiol. 2013;51(7):2182-2194.JAAD CASE REPORTSMAY 202122 Basal et al

Facklamia hominis in hidradenitis suppurativa

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