A Skin Ulceration Complicated by Alcaligenes Xylosoxidans Infection

ABSTRACT

A. xylosoxidans infection can result in potentially severe sequelae, especially in unhealthy populations. We present a rare case of infectious skin ulceration with scar contracture due to A. xylosoxidans in a healthy patient. A 53-year-old male patient without underlying disease and trauma history visited our department for an irritating skin ulcer with purulent discharge on the right lower leg. The chronic wound on the leg exists since he got contact burn 30 years ago. The wound did not respond to treatment, and the wound culture results indicated A. xylosoxidans. Given the incurable character of A. xylosoxidans, we performed a wide excision and split thickness skin graft with collagen-elastin matrix (Matriderm(R)). A. xylosoxidans is an opportunistic, aerobic, gram-negative, rod-shaped bacterium that is oxidase positive. According to reports, A. xylosoxidans is not sensitive to many antibiotics and can cause bacteremia. It is suggested that the blood supply is compromised near a scar lesion despite the fact that blood flow is rather increased during the initial scar formation phase. Therefore, we presumed that the infection was most likely caused by low blood circulation due to scar contracture. Thus, when a scar contracture is present, A. xylosoxidans infection can manifest in a healthy patient.