De-identified Clinical Data Supporting Case Report: Disseminated B. cepacia Detected by Plasma mcfDNA Sequencing in a Child With MRSA Abscess Prompting Diagnosis of CGD

Case Presentation: An 11-month-old male presented to the Emergency Department with 17 days of fever, irritability, and cervical lymphadenopathy unresponsive to outpatient antibiotics. Physical exam demonstrated extremity rash, oral ulcers, and bilateral cervical lymphadenopathy. Initial infectious workup was negative including blood culture, CMV and EBV serology. Abdominal imaging demonstrated a hepatic abscess, and multiple splenic and hepatic lesions interpreted as granulomas. Culture of liver abscess drainage grew methicillin-resistant S. aureus (MRSA). Fevers and lymphadenopathy continued despite vanocmycin, with no evidence of spread or recurrence of MRSA. Plasma mcfDNA-Seq identified Burkholderia cepacia, prompting addition of intravenous trimethoprim-sulfamethoxazole with rapid resolution of symptoms. Subsequent genetic and dihydrorhodamine flow cytometric testing confirmed the suspected diagnosis of CGD.