This conference centered on two oncology-associated fever cases. The first involved a patient with metastatic colorectal cancer, recent ERCP and biliary stenting, and recurrent ESBL UTIs who developed fever and sepsis during admission; blood cultures grew Cronobacter sakazakii, prompting discussion of possible biliary versus other sources and the organism’s unusual biology. The teaching portion reviewed Cronobacter taxonomy, environmental persistence, xerotolerance and thermotolerance, classic association with infant formula, and invasive disease in both neonates and immunocompromised adults.
The second case involved a young patient with extraskeletal Ewing sarcoma on chemotherapy who presented with acute fever, axillary fullness near a PICC, and a pre-existing knee lesion. This case was used to discuss ecthyma gangrenosum as a syndrome not limited to neutropenic pseudomonal bacteremia, with a broader differential that includes organisms such as Fusarium, Staphylococcus aureus, Candida, and Aeromonas. A key practical theme was the importance of asking carefully about the timing of skin lesions and line exposures when evaluating fever in immunocompromised patients.