Hypothermia predisposing to Pseudomonas putida sepsis in a child with panhypopituitarism

A 14-year-old boy presented with a 1-week history of hypothermia and obtundation. His medical history included surgical resection of craniopharyngioma with postoperative visual impairment and panhypopituitarism. The patient's rectal temperature remained persistently lower than 35°C during the first 3 days of hospitalization. His blood pressure was 90/56 mmHg on admission. The peripheral blood leukocyte count was 2.7 x 1010/L with 18% neutrophils, 19% band forms, 44% metamyelocytes, 3% myelocytes, and 16% lymphocytes. The C-reactive protein concentration was 133.9 mg/L. Two separate blood cultures both yielded Pseudomonas putida. The patient was treated with amikacin and ceftazidime along with aggressive fluid therapy. Replacement therapy directed at his hormonal deficiencies was initiated as soon as his hemodynamic status was stabilized. The patient responded well to therapy with a gradual rise in body temperature and improvement in general activity. A growth experiment carried out on the P. putida isolate showed that the bacteria grew more rapidly at 30°C than at 37°C. The clinical course of the patient, as well as the results of the laboratory study, suggest that hypothermia may predispose human infection with P. putida.