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A6666 - A Rare Cause of Empyema in a Patient with Germ Cell Tumor
Author Block: R. Mangat1, A. Eranki2; 1Medicine, SUNY Upstate Medical University, Syracuse, NY, United States, 2Infectious Disease, SUNY Upstate Medical University, Syracuse, NY, United States.
Salmonella species are gram-negative, flagellated facultatively anaerobic bacilli that are known to cause syndromes ranging from mild gastroenteritis to enteric fevers. Salmonella typhi and Salmonella paratyphi cause enteric fever whereas other nontyphoidal salmonellae typically cause symptoms related to gastroenteritis. Humans contract nontyphoidal salmonellosis by eating food contaminated by fecal matter or from infected animal products. Symptoms typically include diarrhea, abdominal cramps, nausea, vomiting and fevers and the disease course is self-limiting. Pleuropulmonary infections secondary to Salmonella species are rare with only a limited number of reported cases in the literature. Here, we present a young immunocompromised male who was found to have Salmonella empyema. A 21-year-old male with a recent diagnosis of non-seminomatous mediastinal germ cell tumor presented to the hospital for elective chemotherapy. He complained of a persistent non-productive cough for several days prior to admission which was thought to be secondary to his mediastinal mass. He continued to feel short of breath while in the hospital which was further evaluated by a CT thorax which showed a loculated left pleural effusion with partial collapse of the left upper and lower lobes, requiring chest tube placement. Pleural fluid culture grew Salmonella non-typhi. Despite taking an extensive history, we were unable to find any exposure risks to Salmonella or the source of infection. Patient was started on ceftriaxone 2 grams daily and transitioned to ciprofloxacin 500 milligrams twice a day for a total of four weeks from chest tube placement. Symptoms of empyema include pleuritic chest pain, fever, cough and dyspnea. Although Salmonella empyema is a rare diagnosis, it is an important etiology to consider in patients who are immunocompromised, have had significant exposure to Salmonella or prior lung disease. Few cases of Salmonella empyema have been reported in immunocompromised individuals including those who have Human immunodeficiency virus infection, history of malignancy, diabetes, use of steroids and chronic renal failure. Risk factors include infected food products, recent travel to endemic areas which include South East Asia and Africa, as well as exposure to pet turtles, iguanas and chicks. Finally, it has been reported that thirty-eight percent of patients who were found to have Salmonella empyema had pre-existing lung disease. Salmonella empyema should be considered as a differential in the above populations as early diagnosis and treatment with antimicrobials along with surgical intervention is necessary to prevent poor outcomes.