Recurrent Helicobacter cinaedi bacteremia cured with long-term oral minocycline treatment in a patient undergoing hemodialysis: a case report and literature review

Abstract

Abstract Background Helicobacter cinaedi is a Gram-negative spiral bacillus that inhabits the intestines of animals. First reported in 1984 as the causative agent of proctitis in a homosexual man, it causes bacteremia, cellulitis, and infections in many organs and tissues, particularly in immunocompromised patients. The clinical challenge with H. cinaedi infection includes its slow growth rate and weak Gram staining that make it easy to misdiagnose, as well as the high incidence of relapses after the discontinuation of antibiotics. Herein, we report a case of delayed diagnosis of H. cinaedi bacteremia in a patient undergoing hemodialysis, where long-term minocycline therapy proved effective. Case presentation A 59-year-old woman undergoing maintenance hemodialysis for lupus nephritis presented with a high fever. She was thought to have a bacterial infection and was initially treated with tazobactam/piperacillin, resulting in a good response and discharge. Soon after discharge, the fever recurred, leading to readmission for further evaluation. After admission, polymerase chain reaction and sequencing of the blood culture sample taken during the first admission revealed that she had H. cinaedi bacteremia. The fever promptly subsided with the administration of meropenem. However, long-term antibiotic use was deemed necessary, and oral minocycline therapy was initiated. Minocycline was administered for 12 weeks, leading to complete resolution of infection. Conclusions In cases of recurrent fever following antibiotic treatment, especially in immunocompromised patients, H. cinaedi infection should be considered, warranting appropriate culture testing and antibiotic therapy. Oral minocycline is considered an effective treatment option in such cases.

Keywords

• Bacteremia
• Helicobacter cinaedi
• Hemodialysis
• Minocycline
• Recurrent fever