# Ignatzschineria indica Bacteremia Initially Misdiagnosed in a Patient With a Maggot-Infested Wound

## TL;DR

A 72-year-old man with a maggot-infested wound was found to have a rare bacterial infection, highlighting the importance of accurate diagnosis in complex wound cases.

## Contribution

This case report adds to the limited literature on Ignatzschineria indica bacteremia associated with maggot-infested wounds.

## Key findings

- The patient's initial blood culture misidentified the pathogen as Corynebacterium jeikeium, but further testing confirmed Ignatzschineria indica.
- Appropriate antibiotic treatment with levofloxacin led to clinical improvement and successful discharge.
- The case emphasizes the need for awareness of emerging pathogens in managing complex wound infections.

## Abstract

Gram-negative bacteremia in hospitalized patients often leads to prolonged hospital stays, increased healthcare costs, and mortality rates. Simultaneously, the presence of comorbidities like chronic wounds increases the risk of severe infection and complicated hospital courses involving amputation, broad-spectrum antibiotic use, and repeat hospital admissions, after discharge. This case presents a 72-year-old male with a past medical history significant for chronic lower extremity cellulitis with multiple prior hospitalizations. On admission, the patient had a chief complaint of progressively worsening left lower extremity pain along with nausea, vomiting, and diarrhea. CT imaging of the left lower extremity suggested severe cellulitis without signs of osteomyelitis. Blood cultures initially suggested Corynebacterium jeikeium, but were sent to an outside facility due to ambiguity of results. The outside facility identified the pathogen as Ignatzschineria indica. After confirming the results, antibiotics were appropriately de-escalated to oral levofloxacin. The patient continued to show clinical improvement and was discharged with follow-up appointments scheduled for infectious disease and bi-weekly visits to wound care. Considering the increasing prevalence of chronic wounds in the United States, awareness and recognition of emerging pathogens are crucial for the timely diagnosis, treatment, and management of these complex patients. Our case adds to the growing body of reports on the management of I. indica bacteremia resulting from maggot-infested wounds.