# A Line Full of Lessons: A “Sake Lees”-Like Mass Revealing Bacillus cereus Contamination in an Amino Acid Infusion

## TL;DR

A case report shows how a strange substance in an amino acid infusion line helped diagnose a dangerous infection caused by Bacillus cereus in a hospitalized patient.

## Contribution

Highlights a novel visual clue, 'sake-lees'-like aggregates, aiding in the diagnosis of Bacillus cereus bloodstream infections.

## Key findings

- Whitish, turbid crystalline aggregates in infusion lines indicated Bacillus cereus contamination.
- The case emphasizes the risk of B. cereus in amino acid infusions for vulnerable patients.
- Visual inspection of infusion lines can serve as a diagnostic clue for catheter-related infections.

## Abstract

Bacillus cereus (B. cereus) is a known cause of catheter-related bloodstream infections (CRBSIs) in healthcare settings, with increased risk observed in immunocompromised patients and those receiving amino acid-based parenteral nutrition. This condition is typically identified by local signs at the catheter insertion site and positive blood cultures. We report a case of an elderly hospitalized patient in whom an unusual visual finding, whitish, turbid, “sake-lees”-like crystalline aggregates within the infusion line, contributed to the diagnosis of B. cereus-associated CRBSIs. This case underscores the potential routes of B. cereus contamination in the medical environment and highlights the importance of rigorous infection control practices during infusion preparation and catheter-related procedures for hospitalized patients.