Case Report

False-Positive Blood Cultures in Acute Leukemia: An Underrecognized Finding

Table 1

Summary of previous case reports.

PatientBlood culture results

Martinez et al. [6]67-year-old male. 2 months history of asthenia. Fever 37.5–38°C. Acute myelomonocytic leukemia. WBC count=150×109/L (95% blasts).(i) AMDS: BACTEC NR730 and BacT/ALERT.
(ii) All 6 blood culture bottles were flagged positive: at 18 hours (aerobic, BACTEC NR370), 48 hours (anaerobic BACTEC NR370), 3.3 and 3.4 hours (two anaerobic bottles, BacT/ALERT), and at 12.2 hours (both aerobic bottles, BacT/ALERT).
(iii) No information on the CO2 plot.
Meessen et al. [7]56-year-old female with a 3-week history of malaise and fever (39°C). Diagnosed with AML. WBC count=446 × 109/L (100% blasts).(i) AMDS: BACTEC 9240.
(ii) Two culture bottles (BACTECPLUS/F, aerobic, and anaerobic bottle) (from a total of 4 sets) flagged positive at 19.1 (aerobic) and 4.3 (anaerobic) hours.
(iii) The shapes of the growth curves were indistinguishable from those observed during bacterial growth.
Khan et al. [8]67-year-old male, with relapsed/refractory AML. Presentation with fever, fatigue, and mucositis. The patient was on protocol therapy with azacitidine and nivolumab for relapsed disease. Maximum recorded fever 38.6°C. A chest computed tomography showed no evidence of infection. WBC count=37 × 109/L (87% blasts).(i) AMDSs: BACTEC FX.
(ii) The single blood culture obtained (BACTECPLUS/F, aerobic culture bottle) was flagged positive at 14 hours.
(iii) Linear CO2 plot.
Our case70-year-old male with asthenia and low-grade fever. Maximum recorded fever 38.5. Diagnosed with acute monocytic leukemia (FAB M5). WBC count=127 × 109/L (82% blasts).(i) AMDS: BacT/ALERT 3D.
(ii) 4 false-positive blood culture bottles. BacT/ALERT SA (aerobic culture taken at day 1) flagged positive at 11.3 hours, BacT/ALERT SA (aerobic culture taken at day 2) flagged positive at 9.4 hours, BacT/ALERT SN (anaerobic culture taken at day 2) flagged positive at 4.1 hours, and BacT/ALERT FN Plus (anaerobic culture taken at day 5) flagged positive at 2.2 hours. 7 subsequent blood cultures were negative.
(iii) Linear CO2 plot in all four false-positive cultures.

AMDS: automated microbial detection system; AML: acute myeloid leukemia; WBC: white blood cells.