MEDICAL ILLUSTRATION Chromobacterium violaceum: The Deadly Sepsis Guntur Darmawan, R. N. Yasmin Kusumawardhani, Bachti Alisjahbana, Trinugroho H. Fadjari Department of Internal Medicine, Faculty of Medicine Universitas Padjadjaran – Hasan Sadikin Hospital, Bandung, Indonesia. Corresponding Author: Guntur Darmawan, MD. Department of Internal Medicine, Faculty of Medicine Universitas Padjadjaran - Hasan Sadikin Hospital. Jl. Pasir Kaliki No.190, Bandung 40173, Indonesia. email: guntur_d@yahoo.com. Figure 1. Difuse, indurated, partly fuctant, purplish swelling of right hemifacial Figure 2. Chromobacterium violaceum growing on agar Chromobacterium violaceum is a Gram- negative facultatively anaerobic, oxidase- positive bacterium producing a dark violet antioxidant pigment called violacein. It is an opportunistic pathogen and has an ubiquitous distribution, mainly resides in water and soil of tropical and subtropical regions. 1-3 An-18-year-old man referred to the emergency room with a 5-day history of progressively worsening swelling of the right cheek. He sought consult and hospitalized at another institution for three days prior this admission; however, his condition deteriorated. He had a history of having abscesses several time. Four month before this visit, he was also admitted in our hospital due to an abscess in the right thigh. Pus and blood culture were positive for Staphylococcus haemolyticus , with a total serum IgE of 2493.0 IU/ml. He recovered completely after being treated with vancomycin in this event. He had neither diabetes mellitus nor human immunodefciency virus infection history. In this presentation, he was in a critically ill state with septic shock. Physical examination revealed difuse, indurated, partly fuctuant, and some deep purple area of right hemifacial swelling. It was extended anteriorly from angle of mouth to retroauricular, superiorly from superior palpebra to lower border of mandible (Figure 1). Laboratory studies were notable for a white-cell count of 12,970/mm 3 (total lymphocyte count 778.2), platelet count 96,000/mm 3 . The patient got norepinephrine drip and broad-spectrum antibiotic intravenously. 80 Acta Med Indones - Indones J Intern Med • Vol 50 • Number 1 • January 2018