Raoultella planticola Pneumonia in an Elderly Gardener: A Case Report and Literature Review

TL;DR

An elderly gardener developed a rare bacterial pneumonia caused by Raoultella planticola, highlighting the importance of considering unusual pathogens in severe respiratory infections.

Contribution

This case report adds to the limited literature on R. planticola as a cause of severe pneumonia and emphasizes diagnostic approaches in atypical infections.

Findings

R. planticola was identified as the cause of pneumonia leading to shock and multiorgan failure in an elderly patient.

Bronchoalveolar lavage was crucial in diagnosing the infection when initial cultures were negative.

Environmental exposure through gardening is suggested as the likely source of infection.

Abstract

Raoultella planticola is a rare gram-negative bacillus, mostly found in the environment. It has been rarely identified as the source of infection, particularly in the respiratory tract, leading to shock and multiorgan failure. Limited cases have been reported in the past years, representing a diagnostic challenge.

We report a case of a 93-year-old African American female patient with a history of hypertension, type 2 diabetes, cerebrovascular disease, and dementia who presented with a two-week history of progressive respiratory symptoms, including dyspnea, productive cough, and altered mental status. She rapidly developed respiratory failure and shock, requiring intubation, mechanical ventilation, and vasopressor support. Bronchoalveolar lavage (BAL) cultures reported isolated pansensitive R. planticola. Further investigation revealed that the patient was an avid gardener with prolonged exposure to environmental soil and plant material, which is believed to be the source of the infection. She received treatment with intravenous ceftriaxone with the resolution of symptoms.

This case showcases the rare presentation of R. planticola pneumonia leading to shock and multiorgan failure in an elderly patient. It highlights the importance of considering atypical pathogens as a cause of community-acquired pneumonia, and the value of BAL in identifying rare organisms when initial cultures are negative and clinical deterioration persists.

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