• Qian Yang, Qiong Zhong, Bo Wu, XiaoDu Xu, WeiMin Li, BoHao Zhao, Min Luo, XingHua Zhu, Dan Ye, and YanChun Huang.
• Department of Laboratory Medicine, The First People's Hospital of Longquanyi District, Chengdu/West China Longquan Hospital Sichuan University, Chengdu, China.
• Medicine (Baltimore). 2023 Nov 17; 102 (46): e36087e36087.

RationaleActinobacillus ureae (A. ureae) is an unusual commensal of human respiratory flora, rarely causing human infection. The predisposing factors, identification, clinical features, and antibiotic therapy of A. ureae are seldomly reported. Herein, we present a case of 64-year-old man affected by A. ureae pneumonia after intracranial surgery.Patient Concerns And DiagnosesA 64-year-old male was admitted with vomiting, drowsiness, and a severe disturbance of consciousness and was later diagnosed with cerebral hemorrhage by computed tomography images. After a craniocerebral surgery, the patient suffered from intractable pneumonia, experiencing treatment failure with multiple anti-bacterial agents. Sputum culture yield pure colonies of A. ureae, confirmed by matrix-assisted laser desorption/ionization time of flight and 16S rRNA gene sequencing.InterventionsMinocycline (100 mg p.o. per 12 hours) with a course of 15 days was administrated for this patient.OutcomesThe respiratory symptoms, presenting as intermittent coughing with purulent and yellowish sputum, were gone. A 3-month follow-up examination showed a complete resolution of radiological findings.LessonsClinically, the actual incidence of A. ureae pneumonia may be higher than that we generally recognized, and clinicians should consider A. ureae as a possible etiologic agent in patients with predispositions. Currently, A. ureae may be susceptible to penicillin, ampicillin, and third-generation cephalosporins. Other antibacterial agents, such as tetracycline, amoxicillin/clavulanic acid, and aminoglycosides also respond well and can be a choice in the treatment of A. ureae infections.Copyright © 2023 the Author(s). Published by Wolters Kluwer Health, Inc.

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