To the Editors: Sepsis caused by Burkholderia multivorans, a member of the Burkholderia cepacia complex, is typically associated with immunocompromised hosts, particularly patients with cystic fibrosis.1 Reports of fulminant sepsis due to B. multivorans in previously healthy children are exceedingly rare, and its association with rhabdomyolysis has been only sporadically described.2,3 We report a fatal pediatric case of rapidly progressive sepsis with severe rhabdomyolysis in which B. multivorans was identified exclusively by next-generation sequencing combined with advanced bioinformatics technologies,4 highlighting important diagnostic and clinical implications for pediatric infectious diseases practice. A previously healthy 3-year-old girl presented with fever and upper respiratory symptoms and was diagnosed with a viral upper respiratory infection and initially discharged home. Within hours, she developed cardiopulmonary collapse at home, was resuscitated, and admitted to the pediatric intensive care unit. Despite aggressive supportive care, including intravenous fluid resuscitation with normal saline, broad-spectrum antimicrobial therapy (ceftriaxone), vasoactive agents and steroid therapy, her condition deteriorated rapidly. Markedly elevated creatine phosphokinase levels (>100,000 U/L) and myoglobinuria were consistent with fulminant rhabdomyolysis. Blood and urine cultures remained negative, and extensive metabolic evaluations were unrevealing. The patient died 36 hours after admission. Because conventional microbiologic investigations failed to identify a causative pathogen, metagenomic next-generation sequencing was performed on acute-phase serum samples. After removal of human genomic sequences and bioinformatic analysis using validated pipelines (MePIC), B. multivorans sequences were detected, establishing the diagnosis of systemic infection.4,5 Autopsy findings demonstrated diffuse rhabdomyolysis and bronchopneumonia (Fig. 1).FIGURE 1.: Photomicrographs of the rectus abdominis muscle. Hematoxylin and eosin (HE) staining ×400. Transverse section (A) and longitudinal section (B) of the rectus abdominis muscle. Findings of rhabdomyolysis are observed, with loss of muscle striation (arrow). Scale bars, 20 μm.This case raises important considerations for pediatric clinicians. First, B. multivorans should be recognized as a potential cause of rapidly progressive sepsis even in immunocompetent children. Second, severe rhabdomyolysis may represent a catastrophic manifestation of overwhelming systemic inflammation in Burkholderia infection and should prompt immediate intensive management. Third, given the intrinsic antimicrobial resistance of B. multivorans, standard empiric regimens such as third-generation cephalosporins may be insufficient, underscoring the importance of early pathogen identification.
Ishii et al. (Wed,) studied this question.