A Case of Catheter-Related Bacteremia of Tsukamurella pulmonis

Tsukamurella pulmonis is an aerobic actinomycete. We report a catheter-related bacteremia of T pulmonis. A 39 yr-old male with ALL was hospitalized to receive bone marrow transplantation (BMT). Although the patient developed a high fever at the 7th hospital day (HD), it subsided with vancomycin treatment, and he received BMT at 9th HID. Fever resurged at 16th HID despite sustained treatment with vancomycin, meropenem, and amphotericin B, but subsided with removal of Hickman catheter (HC) at 19th HID. Three sets of blood cultures comprising one from the HC and two from venipunctures were taken at 7th, 16th, and 19th HID, and the distal tip of the HC was also cultured. The aerobic vials of all 3 HC-withdrawn blood cultures and one peripheral blood culture taken at 19HD and the HC tip culture grew long, straight, thin gram-positive rods that were positive on modified Kinyoun stain. This organism showed tiny, rough, grey colonies after 3-day incubation and grew to large flat colonies when incubation was extended. It was catalase-positive, urease-positive, and alkaline-slan/alkaline-deep on triple sugar iron agar, and hydrolyzed hypoxanthine. The sequence of 1,296 base pairs of 16S rRNA of this organism showed a 100.0% homology with the published sequence of T pulmonis DSM 44142 T. To our knowledge, this is the first report of T pulmonis bacteremia in Korea. (Korean J Lab Med 2009;29:41-7)