Home
|
Inbox
|
Search
|
View Abstract
Getting It off Your Chest: A Case of Actinomyces Israelii Causing Empyema Necessitans
Description
.abstract img { width:300px !important; height:auto; display:block; text-align:center; margin-top:10px } .abstract { overflow-x:scroll } .abstract table { width:100%; display:block; border:hidden; border-collapse: collapse; margin-top:10px } .abstract td, th { border-top: 1px solid #ddd; padding: 4px 8px; } .abstract tbody tr:nth-child(even) td { background-color: #efefef; } .abstract a { overflow-wrap: break-word; word-wrap: break-word; }
A6664 - Getting It off Your Chest: A Case of Actinomyces Israelii Causing Empyema Necessitans
Author Block: A. Bello1, D. Sese2, H. Kakarala3; 1Cleveland Clinic- Akron General, Akron, OH, United States, 2Internal Medicine, Cleveland Clinic Akron General, Akron, OH, United States, 3Cleveland Clinic Respiratory Institute of Akron, Copley, OH, United States.
Empyema is commonly caused by anaerobic organisms and is associated with recurrent aspiration.1 Actinomyces has been identified as a rarer cause of empyema in immunocompromised hosts.(1,2) We report a case of an immunocompetent patient who presents with empyema necessitans with recurrent empyema from Actinomyces Israelii.
A 53 year old male presents with weight loss and a persistent cough for the past eleven years. His history is significant for a recurrent right sided empyema despite treatment with broad spectrum antibiotics, pleurodesis, decortication and recurrent chest tube insertions. He reports drainage coming from a previous chest tube insertion site with coughing. He denies fevers, chills and dyspnea. Exam reveals a cachectic gentleman in no distress. He has poor dentition and there is erythema and induration around a previous chest tube site that is draining foul smelling fluid. On auscultation there is diminished breath sounds at the right lower lung fields, bilateral rhonchi and no crackles. His neck veins are flat and he has no pedal edema. His complete blood count showed no leukocytosis with some reactive thrombocytosis. His erythrocyte sedimentation rate is 104 mm/hr and c-reactive protein is 10.9 mg/L. His albumin is 2g/dl.
A chest computerized tomography (CT) scan showed a 9cm x 4.5cm loculated right effusion. He was started on Ampicillin-Sulbactam for suspicion of Actinomycosis and was taken for repeat decortication. Bronchoscopy and lavage were performed to clear mucus. Airway inspection revealed chronic inflammation and volume loss likely from recurrent infection. Culture results confirmed an infection with Actinomyces israelii. He was treated with intravenous Ampicillin-Sulbactam for six weeks and continued on one year of oral penicillins. He was found to have moderate oropharyngeal dysphagia and was discharged on nectar thick liquids.
Empyema necessitans is described as a purulent pleural effusion which, due to increased pressure within loculations, expands beyond the pleural cavity into surrounding structures.(1,3-5) More commonly seen in tuberculous infections, empyema from Actinomyces is rarely reported.(1) Accounting for 15-20% of all reported Actinomyces infections, risk factors for developing pulmonary actinomycosis include normal oral flora, poor dentition, host immune status and defective swallowing mechanisms.(3,6-7) Common presentations include weight loss, fever, cough, pleuritic chest pain, hemoptysis, anemia, and leukocytosis.(3)
Empyema necessitans caused by Actinomyces israelli has been a rarely reported entity in literature. Pitfalls of diagnosis include presentation as other more common infections, suspected malignancy and low index of suspicion for Actinomyces.(2,6, 8) Treatment includes broad spectrum antibiotics and surgical drainage.
Author Block: A. Bello1, D. Sese2, H. Kakarala3; 1Cleveland Clinic- Akron General, Akron, OH, United States, 2Internal Medicine, Cleveland Clinic Akron General, Akron, OH, United States, 3Cleveland Clinic Respiratory Institute of Akron, Copley, OH, United States.
Empyema is commonly caused by anaerobic organisms and is associated with recurrent aspiration.1 Actinomyces has been identified as a rarer cause of empyema in immunocompromised hosts.(1,2) We report a case of an immunocompetent patient who presents with empyema necessitans with recurrent empyema from Actinomyces Israelii.
A 53 year old male presents with weight loss and a persistent cough for the past eleven years. His history is significant for a recurrent right sided empyema despite treatment with broad spectrum antibiotics, pleurodesis, decortication and recurrent chest tube insertions. He reports drainage coming from a previous chest tube insertion site with coughing. He denies fevers, chills and dyspnea. Exam reveals a cachectic gentleman in no distress. He has poor dentition and there is erythema and induration around a previous chest tube site that is draining foul smelling fluid. On auscultation there is diminished breath sounds at the right lower lung fields, bilateral rhonchi and no crackles. His neck veins are flat and he has no pedal edema. His complete blood count showed no leukocytosis with some reactive thrombocytosis. His erythrocyte sedimentation rate is 104 mm/hr and c-reactive protein is 10.9 mg/L. His albumin is 2g/dl.
A chest computerized tomography (CT) scan showed a 9cm x 4.5cm loculated right effusion. He was started on Ampicillin-Sulbactam for suspicion of Actinomycosis and was taken for repeat decortication. Bronchoscopy and lavage were performed to clear mucus. Airway inspection revealed chronic inflammation and volume loss likely from recurrent infection. Culture results confirmed an infection with Actinomyces israelii. He was treated with intravenous Ampicillin-Sulbactam for six weeks and continued on one year of oral penicillins. He was found to have moderate oropharyngeal dysphagia and was discharged on nectar thick liquids.
Empyema necessitans is described as a purulent pleural effusion which, due to increased pressure within loculations, expands beyond the pleural cavity into surrounding structures.(1,3-5) More commonly seen in tuberculous infections, empyema from Actinomyces is rarely reported.(1) Accounting for 15-20% of all reported Actinomyces infections, risk factors for developing pulmonary actinomycosis include normal oral flora, poor dentition, host immune status and defective swallowing mechanisms.(3,6-7) Common presentations include weight loss, fever, cough, pleuritic chest pain, hemoptysis, anemia, and leukocytosis.(3)
Empyema necessitans caused by Actinomyces israelli has been a rarely reported entity in literature. Pitfalls of diagnosis include presentation as other more common infections, suspected malignancy and low index of suspicion for Actinomyces.(2,6, 8) Treatment includes broad spectrum antibiotics and surgical drainage.
|
Home
|
Inbox
|
Search
|