Refractory to treat Helicobacter cinaedi bacteremia with bilateral lower extremities cellulitis in an immunocompetent patient.

Helicobacter cinaedi is known to cause bacteremia with multi-focal cellulitis, usually, among immunocompromised patients. We report here a 54-year-old Japanese man who was found to have bacteremia complicated with bilateral lower extremities cellulitis due to H. cinaedi. This patient did not have any immunocompromised conditions including Human Immunodeficiency Virus infection. In this patient, the cellulitis was multi-focal which is rare among immunocompetent patients. In addition, interestingly, the cellulitis was symmetrically on the both sides on the lower dorsal part of the extremities. The patient was treated with meropenem, which was considered as one of the best available agents, however, he required a prolonged antimicrobial treatment. During the admission, he underwent colonoscopy which was unremarkable, and his stool culture was also negative while on meropenem. Subsequently, he developed recurrent symptoms of the right lower extremity twice and each time he was treated with intravenous meropenem followed by oral minocycline. After the total of 12 weeks of antimicrobial treatment, his symptoms subsided. Clinicians should be aware of this organism when treating multi-focal, or symmetrical cellulitis even if the patients are immunocompetent.