Acinetobacter baumanii is a well-known causative agent of nosocomial infections. However, community-acquired A. baumanii pneumonia is rare in the United States; thus, we present this case of community-acquired pneumonia with a fulminant course. A 75-year-old Caucasian male with hypertension, moderate chronic obstructive lung disease, alcoholism, and diabetes mellitus presented with dyspnea, changes in behavior, hypotension, and hypoxemia with diffuse wheezes and crackles. Chest radiography showed dense right base infiltrate. He had profound respiratory distress started on BiPAP support and was treated with azithromycin and ceftriaxone. Blood Gram stain showed gram-negative diplococci, suggesting Neisseria meningitidis infection. CSF fluid was negative for infection. Final blood culture grew A. baumanii. Antibiotics were changed to imipenem and vancomycin. His condition continued to deteriorate, and the patient's family decided to withdraw care, leading to the patient's demise. Risk factors associated with community-acquired Acinetobacter pneumonia are smoking, significant alcohol use, and/or concomitant comorbid conditions (COPD, HTN, DM). Patients present with fever, cough, and dyspnea and progresses to shock with a very fulminant course. A HIGH index of suspicion is warranted during the initial course. The organism has been described as a gram-negative coccibacilli. Rarely, as in our case, it may initially be described as a gram-negative diplococcus, leading to the delay in appropriate therapy. With the increasing prevalence of hospital-acquired Acinetobacter infection, we need to maintain high vigilance in the bacterial flora responsible for community-acquired pneumonia.
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