Rhizobium Radiobacter Infection in a 27-Year-Old African American Woman with Munchausen Syndrome

Abstract

Rhizobium radiobacter is an opportunistic, usually saprophytic, gram-negative bacillus found in agricultural soil. Isolation from blood has been reported most often in hospitalized patients harboring malignant neoplasms or human immunodeficiency virus (HIV) associated immunosuppression, who have catheter or medical device-related febrile neutropenia; treatment involves removal of the catheter or implanted medical device.1 Herein, we report a case of a 27-year-old African American woman with sickle cell anemia who sought treatment of generalized body pain, shaking, chills, dyspnea, and fever, suggestive of sickle cell crisis. As part of her work up, routine blood cultures were drawn, revealing the presence of a Gram negative bacillus that was identified as the nonfermenter bacillus R. radiobacter. The patient displayed a unique infection with R. radiobacter sepsis in a patient secondary to self-injection of organic material into a peripheral line during hospitalization. The growth of an unusual organism in the blood of a patient, without the usual risk factors of R. radiobacter, raised suspicion of a factitious psychiatric disorder known as Munchausen syndrome, which was confirmed when we discovered self-injection of feces and dirt into a central intravenous (IV) line.