Background: Even though enterococci can cause serious infections in multiple sites, they are a rare cause of\npneumonia. We reported a uremic patient with vancomycin-resistant E. faecium (VRE-fm) pneumonia, possibly\nrelated to epileptic seizures.\nCase presentation: A 57-year old man with uremia on hemodialysis was admitted to the hospital with complaint\nof recurrent epileptic seizures, followed by a two-week history of recurrent fever and cough with purulent sputum.\nChest CT demonstrated multiple exudation of both lungs. He was diagnosed as community acquired pneumonia.\nDespite antibiotic combination therapy, abnormal chest shadows aggravated. Sputum and blood cultures were\ninitially negative, but later blood culture grew VRE-fm. We suspected aspiration of gastrointestinal content induced\nby epilepsy as the most likely mechanism. The patient was successfully treated with a four-week course of linezolid\naccording to the antibiotic susceptibility testing.\nConclusions: Physicians should consider multi-drug resistant organisms such as VRE in uremic patients with\npneumonia that fails to resolve with broad-spectrum antibiotics, especially in the cases with aspiration induced by\nepilepsy, immunocompromised conditions, and repeated or prolonged hospitalizations.
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