Surreal illustration of lungs with red pigment bacteria, representing Serratia pneumonia and sarcoidosis.

Unmasking Serratia Pneumonia: A Hemoptysis Case Study in Sarcoidosis Patients

Lena Kashyap in Health & Wellness August 2025 • 4 min read.

"Learn about a rare pneumonia case in sarcoidosis patients, its diagnosis, treatment, and implications for immunocompromised individuals."

Serratia marcescens is a Gram-negative bacillus known for its vibrant red pigment at room temperature. This bacterium, part of the Enterobacteriaceae family, thrives in various environments, including soil, water, and even our intestines. While it's often associated with hospital-acquired infections, community-acquired cases are rare, making each instance a critical study for understanding its behavior.

A recent case report sheds light on an unusual presentation of Serratia pneumonia, marked by hemoptysis (coughing up blood) in a 37-year-old male. What makes this case particularly intriguing is the patient's underlying sarcoidosis, a condition known to compromise the immune system. This intersection of a rare infection and an existing immune disorder provides valuable insights into diagnostic and therapeutic approaches.

The case underscores the importance of considering atypical infections in immunocompromised individuals and highlights the challenges in differentiating Serratia-related symptoms from those of other respiratory conditions. By delving into the specifics of this case, we can gain a deeper understanding of the complexities involved in diagnosing and managing such rare presentations.

Case Presentation: A Diagnostic Puzzle

Surreal illustration of lungs with red pigment bacteria, representing Serratia pneumonia and sarcoidosis.

In this case, the 37-year-old patient presented with a constellation of symptoms, including productive cough with blood-tinged sputum, intermittent fever, and shortness of breath, which had persisted for approximately 20 days. Notably, he had no history of smoking and was currently unemployed, with instances of homelessness. His medical history was significant only for arterial hypertension, which was being managed with atenolol.

Clinical examination revealed a temperature of 37.8°C and a blood pressure of 140/80 mm Hg. His heart rate was normal at 90 bpm, and oxygen saturation was 94%. Upon lung auscultation, crackles were detected over the lower right lung. Chest X-rays showed bilateral hilar prominence, lower-right lung lobe opacification, and elevation of the right hemidiaphragm.

Key Diagnostic Findings:

Elevated white blood cell count (10,900 cells/µL).
Elevated serum creatinine (2.52 mg/dL) and urea (57 mg/dL).
Slightly elevated serum angiotensin-converting enzyme (57 IU/mL).
Consolidation in the anterior segment of the right lower lobe observed via CT scan.

The challenges of pinpointing the cause were significant. Urine antigen tests for Streptococcus pneumoniae and Legionella came back negative. Bronchoscopy was performed, revealing no endobronchial lesions but showing external compression of the trachea. The BALF (bronchoalveolar lavage fluid) analysis was particularly revealing, showing Serratia marcescens, leading to tailored antibiotic use.

Conclusion: A Call for Vigilance

This case underscores the critical importance of maintaining a high index of suspicion for unusual infections in individuals with underlying immunocompromising conditions, such as sarcoidosis. While rare, Serratia pneumonia can present with atypical symptoms like pseudohemoptysis, making accurate and timely diagnosis essential for effective management and improved patient outcomes. Further research and case studies are needed to better understand the interplay between sarcoidosis and opportunistic infections, ultimately guiding clinical practice and enhancing patient care.

About this Article -

This article was crafted using a human-AI hybrid and collaborative approach. AI assisted our team with initial drafting, research insights, identifying key questions, and image generation. Our human editors guided topic selection, defined the angle, structured the content, ensured factual accuracy and relevance, refined the tone, and conducted thorough editing to deliver helpful, high-quality information.See our About page for more information.

This article is based on research published under:

DOI-LINK: 10.2147/ijgm.s24706, Alternate LINK

Title: Serratia Pneumonia Presenting As Hemoptysis In A Patient With Sarcoidosis: A Case Report

Subject: General Medicine

Journal: International Journal of General Medicine

Publisher: Informa UK Limited

Authors: Paul Zarogoulidis, Kostastantinos Porpodis, Maria Konoglou, Stavros Tryfon, Alexandros Mitrakas, Dimitrios Matthaois, Panagiotis Touzopoulos, Konstantinos Archontogeorgis, Kostas Zarogoulidis, Andrew Koulelidis

Published: 2011-09-01

Everything You Need To Know

What is Serratia marcescens, and why is this pneumonia case significant?

Serratia marcescens is a Gram-negative bacillus known for its vibrant red pigment at room temperature and is part of the Enterobacteriaceae family. While often associated with hospital-acquired infections, understanding community-acquired cases is crucial. In the described case, it presented as pneumonia with hemoptysis. Differentiating Serratia-related symptoms from those of other respiratory conditions can be challenging, requiring a high index of suspicion, especially in immunocompromised individuals.

What were the presenting symptoms and key diagnostic findings in the reported case of Serratia pneumonia?

The patient, a 37-year-old male with underlying sarcoidosis, presented with a productive cough with blood-tinged sputum, intermittent fever, and shortness of breath. Key diagnostic findings included an elevated white blood cell count, elevated serum creatinine and urea, slightly elevated serum angiotensin-converting enzyme, and consolidation in the anterior segment of the right lower lobe observed via CT scan. The challenges included negative urine antigen tests for Streptococcus pneumoniae and Legionella, requiring further investigation through bronchoscopy and BALF analysis.

What diagnostic challenges were encountered, and why was this case ultimately identified as Serratia pneumonia?

The case highlights the diagnostic challenges and the importance of considering atypical infections in immunocompromised individuals, such as those with sarcoidosis. It emphasizes the need for vigilance in identifying rare presentations of common pathogens. The study underscores the value of bronchoscopy and BALF analysis in pinpointing the causative agent, especially when initial tests are inconclusive. Without these interventions, the accurate identification of Serratia marcescens and the prompt initiation of appropriate antibiotic therapy might have been delayed.

What implications does the co-occurrence of Serratia pneumonia and sarcoidosis have for patient management?

Serratia pneumonia presenting as hemoptysis in a sarcoidosis patient underscores the complexity of managing respiratory infections in immunocompromised individuals. Sarcoidosis itself can cause lung inflammation and damage, potentially leading to hemoptysis. When a rare infection like Serratia marcescens is introduced, the diagnostic and treatment landscape becomes even more challenging. This highlights the need for clinicians to consider a broad differential diagnosis and utilize advanced diagnostic techniques to ensure accurate and timely intervention.

Why was the bronchoalveolar lavage fluid (BALF) analysis so important in diagnosing this particular case?

The identification of Serratia marcescens in the bronchoalveolar lavage fluid (BALF) analysis was pivotal. This finding allowed for tailored antibiotic use, addressing the specific infection. Without the BALF analysis, the cause of the patient's pneumonia might have remained unknown, potentially leading to ineffective treatment and adverse outcomes. This case reinforces the importance of thorough microbiological investigation in patients with atypical pneumonia, particularly in those with underlying immunocompromising conditions.