Acinetobacter lwoffii Cellulitis in an Immunocompromised Patient With Decompensated Cirrhosis, Diabetes Mellitus, and Psoriasis Vulgaris: A Case Report

This report describes a case of <i>Acinetobacter lwoffii</i> cellulitis in a 68-year-old woman with multiple immunocompromising conditions. The patient had a history of decompensated cirrhosis secondary to metabolic dysfunction-associated steatotic liver disease (MASLD), type 2 diabetes mellitus, and chronic plaque psoriasis. She was initially admitted with left lower limb pain and subsequently developed cellulitis that responded transiently to cefazolin therapy. Three months after discharge, she was readmitted for a superficial skin defect of the left leg and later developed right thigh cellulitis during cefazolin prophylaxis. Blood cultures grew <i>A. lwoffii</i>, which was susceptible to levofloxacin. The patient was successfully treated with levofloxacin and intravenous immunoglobulin, with resolution of fever and improvement of local inflammatory signs. This case highlights the clinical significance of <i>A. lwoffii</i>, an organism of relatively low virulence, as a causative pathogen in patients with complex immunocompromised states. The convergence of decompensated cirrhosis, diabetes, and psoriasis likely predisposed the patient to this rare infection. Clinicians should be aware of the potential for unusual gram-negative organisms to cause cellulitis in severely immunocompromised individuals and consider culture-directed antimicrobial therapy in management.