• Eli Ben-Chetrit, Marc V Assous, Yonit Wiener-Well, David E Katz, Livnat Kashat, David A Zeevi, Uri P Hadelsberg, Lior Gonen, Nevo Margalit, and Tal Shahar.
• Infectious Diseases Unit, Shaare Zedek Medical Center, Faculty of Medicine, The Hebrew University of Jerusalem, Israel.
• World Neurosurg. 2020 Dec 1; 144: 258-261.e1.

BackgroundSinorhizobium meliloti is a phytobacterium found in the root nodules of plants, where it is involved in fixing nitrogen for delivery to the roots in exchange for a photosynthate carbon source. There have been no reported cases of S. meliloti infection in humans. We conducted a retrospective review of clinical records and diagnostic tests.Case DescriptionAn 81-year-old woman who presented to the emergency department with a 1-day history of progressive decline in her level of consciousness following a head injury and deep scalp laceration. Her medical history was significant for a ventriculoperitoneal shunt due to normal pressure hydrocephalus. Imaging studies revealed hydrocephalus and a tear in the shunt catheter. Cerebrospinal fluid analysis was not suggestive for meningitis. Cerebrospinal fluid culture revealed an unfamiliar organism, identified as S. meliloti following sequencing of its entire genome, which was considered a contaminant. The patient subsequently developed peritonitis, and the same pathogen was detected in the peritoneal fluid, suggesting distal shunt infection. Symptoms resolved after shunt removal and antibiotic treatment. Thorough history taking revealed that the patient had fallen and struck her head against a flowerpot.ConclusionsS. meliloti is a phytopathogen that should not be easily disregarded as a contaminant when isolated from human sterile fluids or tissues. Aggressive management including removal of infected hardware, if present, is required to ensure resolution of infection. It emphasizes the importance of thorough history taking.Copyright © 2020 Elsevier Inc. All rights reserved.

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