Fulminant Chromobacterium violaceum Infection With Suspected Septic Arthritis and a Concurrent Dengue Virus Infection: A Case Report.

Chromobacterium violaceum is a rare but highly virulent Gram-negative organism found in tropical and subtropical environments, associated with rapidly progressive sepsis and high mortality. Musculoskeletal involvement, particularly septic arthritis, is exceedingly uncommon. We report a case of a previously healthy 23-year-old male who presented with progressive left ankle pain, swelling, and fever. Initial evaluation revealed thrombocytopenia, markedly elevated inflammatory markers, and positive serology for Dengue virus infection, suggestive of a possible concurrent infection. Blood cultures grew C. violaceum, confirming bacteremia. Despite initiation of intravenous antibiotics and supportive care, the patient experienced rapid clinical deterioration with septic shock, severe metabolic acidosis, hyperkalemia, and multi-organ failure. He required intubation and vasopressor support but suffered multiple cardiac arrests and died within three days of hospitalization. This case highlights the aggressive clinical course of C. violaceum infection, even in immunocompetent individuals, and underscores the diagnostic and therapeutic challenges associated with this rare pathogen. Concurrent dengue infection may have contributed to immune dysregulation and worsened disease severity. Early recognition, prompt diagnosis, and appropriate antimicrobial therapy are critical in managing C. violaceum infections. Clinicians should maintain a high index of suspicion in patients presenting with rapidly progressive sepsis, especially in endemic regions or in the presence of potential environmental exposure.