Fever of unknown origin in a patient undergoing maintenance therapy for B-cell lymphoma

Abstract

Abstract

Introduction. Patients with B-cell lymphomas are at high risk for developing infectious complications due to secondary hypogammaglobulinemia, immunosuppressive therapy, and prolonged use of central venous access. In this patient population, bacteremias are often associated with catheter-related infections and may be caused by non-fermenting Gram-negative microorganisms with inherent antibiotic resistance, which complicates the selection of empirical therapy.

Aim. The aim of this study was to analyze the clinical features, diagnostic approaches, and treatment strategies for bacteremia caused by Stenotrophomonas maltophilia in a patient with B-cell lymphoma receiving maintenance anti-CD20 therapy, with an assessment of the role of the port system as a possible source of infection.

Materials and Methods. A clinical case of bacteremia in a patient with B-cell lymphoma receiving maintenance anti-CD20 therapy and prolonged central venous access was analyzed. Clinical manifestations, laboratory markers of systemic inflammation, blood culture results, antibiotic susceptibility testing, empirical and adjusted antibacterial therapy, and clinical dynamics after central venous catheter removal were assessed.

Results. The clinical course was characterized by fever without a clearly defined primary site of infection and elevated laboratory markers of systemic inflammation. Blood culture revealed Stenotrophomonas maltophilia, and antibiotic susceptibility testing was performed. Empirical broad-spectrum antibiotic therapy was ineffective due to the pathogen’s inherent resistance. Following adjustment of antibiotic therapy based on the antibiotic susceptibility test results and removal of the central venous catheter, clinical improvement and normalization of laboratory parameters were observed.

Conclusions. This case demonstrates the clinical significance of Stenotrophomonas maltophilia as an opportunistic pathogen in oncohematology patients and underscores the importance of an individualized approach to treating bloodstream infections in this patient population.