Achromobacter xylosoxidans: An uncommon scalp infection leading to alopecia and biofilm formation

Achromobacter xylosoxidans is an emerging opportunistic pathogen causing respiratory and systemic infections, mainly in immunocompromised individuals. Cutaneous infections remain uncommon. We present a unique case of a 60-year-old immunocompetent female with a persistent, pruritic, and malodorous scalp infection for over a year, leading to alopecia and biofilm formation, complicating treatment by increasing antibiotic resistance. Despite lacking typical risk factors, wound culture identified A. xylosoxidans with susceptibility to trimethoprim-sulfamethoxazole, which led to successful treatment alongside surgical debridement. This case highlights the need for clinicians to consider A. xylosoxidans in differential diagnoses of unusual skin infections, especially when biofilm formation is evident, and underscores the importance of targeted antibiotic therapy due to this pathogen's multidrug resistance.