Pan et al. Journal of Medical Case Reports 2011, 5:377 http://www.jmedicalcasereports.com/content/5/1/377 C A S E R E P O R T JOURNAL OF MEDICAL CASE REPORTS Open Access Lobar pneumonia caused by Ralstonia pickettii in a sixty-five-year-old Han Chinese man: a case report Wensen Pan1, Zhiming Zhao2* and Mei Dong3 Abstract Introduction: Ralstonia pickettii is a gram-negative, oxidase-positive bacillus and is an emerging pathogen found in infections described in hospital settings. The cases reported in the literature mostly are nosocomial infections due to contaminated blood products, sterile water, saline, treatment fluids and venous catheters. Human infection unrelated to contaminated solutions is rare. We report a case of lobar pneumonia and pulmonary abscess caused by Ralstonia pickettii in an older patient. Case presentation: A sixty-five-year old Han Chinese man presented having had cough, expectoration, chest pain and fever lasting for twenty days. His medical history was notable for hypertension over the previous ten years, and the habit of smoking for forty years. A thoracic computed tomography scan supported the diagnosis of right- sided lobar pneumonia. A lung biopsy was done and pathological analysis confirmed lobar pneumonia. Two lung biopsy specimens from separate sites grew Ralstonia pickettii. After six days, a repeat thoracic scan revealed a right- sided abscess. A thoracentesis was performed and the purulent fluid grew Ralstonia pickettii. The chest tube remained inserted to rinse the cavity with sterile sodium chloride. He received an antibiotic course of intravenous cefoperazone sodium-sulbactam sodium for eighteen days and imipenem-cilastatin for twelve days. A repeat chest X-ray revealed resolution of the pulmonary abscess and improvement of pneumonia. He remained afebrile and free of respiratory symptoms after treatments. Conclusion: This case demonstrates a Ralstonia pickettii infection in the absence of an obvious nosocomial source. It is possible that such cases will become common in the future. Therefore, further studies are needed to evaluate its sensitivity to common antibiotics. Introduction Ralstonia pickettii (R. pickettii) is an emerging pathogen. It is ubiquitous in nature and is found naturally in soil and groundwater. R. pickettii was first isolated in 1973 and included in the genus Pseudomonas [1]. The rod- shaped organism was reclassified in the Burkholderia and then the Ralstonia genera, receiving its current name in 1995 [2]. R. pickettii is often confused with other similar bacteria, increasing the difficulty of classi- fying and treating this pathogen. R. pickettii can be isolated from various clinical speci- mens, such as sputum, blood, infected wounds, urine, * Correspondence: pwszzmxx@sina.com.cn 2Department of Reproductive Medicine, the Second Hospital of Hebei Medical University, Shijiazhuang, China Full list of author information is available at the end of the article ear, nose swabs, and cerebrospinal fluid. It is also com- monly found in the respiratory tract secretions of cystic fibrosis patients. Most infections with R. pickettii are seen in the hospital setting resulting in bacteremia and/ or septicemia and respiratory infections and/or pneumo- nia [3]. The cases reported in the literature are mostly nosocomial infections due to contaminated solutions including blood products, sterile water, saline, chlorhexi- dine solution, treatment fluids for the respiratory tract, and contaminated venous catheters [4-7]. Human infec- tion unrelated to contaminated solutions is rare. There is only one documented case of an empyema caused by R. pickettii, and our case is similar in some respects [8]. Our case is perhaps the first one reported of a lobar pneumonia and pulmonary abscess caused by R. pickettii. © 2011 Pan et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.