Recurrent Lactobacillus Rhamnoses Bacteremia and Complications in an Immunocompromised Patient With History of Probiotic Use: A Case Report.

The use of probiotics has been on the rise in the past few years. Increasing reports on Lactobacillus bacteremia-associated morbidity and mortality in immunocompromised patients have raised safety concerns about its use in this group. We present a case of a 79-year-old patient with a history of probiotic use who was admitted from the emergency department for acute-on-chronic diarrhea, acute hyponatremia, acute-on-chronic diastolic heart failure, and ambulatory dysfunction. His multiple co-morbidities include stage III chronic kidney disease, type II diabetes mellitus, chronic diastolic heart failure, Parkinson's disease, essential hypertension, atrial fibrillation, status post pacemaker placement, and status post bioprosthetic aortic valve replacement. He was diagnosed with a resistant case of Lactobacillus bacteremia during his admission, with multiple positive blood cultures positive for L. rhamnosus resistant to antibiotics therapy. Unfortunately, due to multiple complications related to Lactobacillus bacteremia, he transitioned to comfort care and ultimately passed away in a few weeks. Although probiotics are generally considered safe, their safety in immunocompromised patients is uncertain. Until more research is available to confirm their safety, caution should be taken when using them in this population. This study is an addendum to the few studies on this topic.