Disseminated Infection Caused by Francisella philomiragia, France, 2014

To the Editor: Francisella philomiragia is a rare opportunistic pathogen.Only 17 cases of infection in humans have been reported over a 40-year period; 15 of these occurred in North America, mainly in persons who had neardrowning experiences and in patients with chronic granulomatous disease (1,2).We describe a case of F. philomiragia infection in a man in France who had the skin lesions of Sweet syndrome, characterized by nodules and pustules with dermal neutrophilic infiltration.In 2014, a 58-year-old diabetic man with myeloproliferative disorders associated with Sweet syndrome (diagnosed in 2012), was hospitalized in the teaching hospital of Lille, France,with a 1-week history of fever (39°C) and cough.Physical examination showed inflammation around a central venous catheter, which was then removed.Blood, urine, and sputum samples that had been collected on admission were analyzed; leukocyte count was 5.83 × 10 9 cells/L (neutrophils 79%) (reference range 4-10 × 10 9 cells/L.Empirical treatment with piperacillin/tazobactam, vancomycin, and gentamicin was initiated.No pathogens were recovered from the samples, although the catheter was positive for Staphylococcus epidermidis and Stenotrophomonas maltophilia.These findings prompted us to replace piperacillin/tazobactam with ticarcillin/clavulanic acid in the treatment regimen.Despite a brief clinical improvement, the patient was highly febrile (40°C) 1 week after admission, and new blood samples were collected.A computed tomography scan of the thorax and abdomen revealed small nodules in the right lung and a single, large, hypodense lesion in the liver.Although histopathologic examination of a percutaneous liver biopsy specimen revealed multiple abscesses, no bacteria were observed after staining and culturing.Thus, the patient's respiratory

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