Achromobacter xylosoxidans is a rare cause of bacteremia; however patients with underlying illness, especially malignancies, are at increased risk of infection. Antibiotic therapy against this pathogen can be difficult owing to its inherent resistance to multiple common antibiotics.

Case Presentation

A 69-year-old male with adenocarcinoma of the colon status post right hemicolectomy and chemotherapy presented with fever and fatigue 10 days following endoscopic retrograde cholangiopancreatography (ERCP) with biliary stent placement for new liver metastases. The patient had undergone partial hemicolectomy and had completed 12 cycles of adjuvant FOLFOX (leucovorin, 5-fluorouracil, and oxaliplatin) at the time of initial diagnosis. Two years following the completion of chemotherapy, the patient was found to have obstructive jaundice and new liver metastases on CT scan. He underwent an ERCP procedure with biliary stenting for palliation and was discharged home.

Ten days following the procedure, the patient presented with complaints of fever to 102oF and fatigue. Vital signs revealed a fever of 101.3oF but were otherwise unremarkable. Physical examination revealed improvement of his jaundice, normal cardiopulmonary examination, and right upper quadrant tenderness. Despite four days of vancomycin and piperacillintazobactam, the patient continued to be febrile to 102.5oF.