Abstract Background Rahnella is a Gram-negative facultative anaerobe. It is typically found in freshwater, oak trees, beetle guts, and onions. Since its discovery in the 1970s, their have been a few documented infections in immunocompromised patients and even fewer in immunocompetent. Case The patient is a 64-year-old female with a past medical history of HTN, CPPD, septic arthritis (was being treated with ertapenem infusions), and diffuse left-sided weakness. Approximately one month prior, she was hospitalized for septic arthritis. Following joint drainage, she was discharged with a PICC line for daily infusions of ertapenem. Synovial fluid cultures were sent to the University of Washington. On the day of readmission, she was brought in by her husband with high-grade fevers (104-105 °F) and rigors shortly after receiving her ertapenem infusion. She was admitted for evaluation of sepsis versus infusion-related reaction. Antibiotics were held to monitor improvement. The cultures from the septic arthritis were positive for Rahnella aquatilis/humidosili. Based on available literature, she was eventually started on doxycycline for an additional 2 weeks for potentially better coverage. Decision-Making The patient was diagnosed with septic arthritis caused by an unidentified pathogen. Given the broad-spectrum coverage of Ertrapenem, outpatient management with ertapenem was considered an appropriate approach. We suspect that the readmission was likely triggered by an infusion reaction, but it helped identify the underlying bacteria. The decision to transition therapy to Doxycycline was made after careful consideration and review of different case studies where Ciproflaxacin and ceftriaxone were utilized.In conclusion, this case report highlights a rare bacterial infection that is not well-recognized. It typically affects immunocompromised people but has also been documented in immunocompetent individuals. Additionally, the lack of consistent antibiotic selection in the literature underscores the need for further studies. This abstract is funded by: None
Nimmagadda et al. (Fri,) studied this question.