CASE 2
A 10 years old girl with early T acute lymphoblastic leukemia presented at emergency room with fever and headache. Five days before admission, she received chemotherapy corresponding to the third consolidation cycle and was neutropenic since then. Laboratory values revealed that the leucocytes count was 60 cells/μL with an absolute neutrophil count of 0 cells/μL. Hemoglobin level was 7.2 g/dL, and platelet count was 2 x 103 cells/μL. CRP level was 27.5 mg/L. She evolved with hypotension and was admitted to PICU. Due to previous carbapenems-resistant Pseudomonas aeruginosa urinary tract infection, vancomycin, meropenem and amikacin were prescribed. Peripheral blood culture was positive at 10 hours of incubation. The quantitative central and peripheral blood cultures were positive for >100 CFU, each for Rothia mucilaginosa.Echocardiogram was normal. Susceptibility in MHB Broth medium showed that Rothia was resistant to sulphamethoxazole/trimethoprim, intermediate to penicillin, and susceptible to vancomycin (MIC ≤ 0.5), erythromycin and clarithromycin. She was transferred to Oncology Unit 48 hours after admission. She was afebrile after 24 hours, with negative blood cultures at 72 hours of treatment. She completed 10 days with intravenous vancomycin with no complications.