A CASE OF EMPYEMA SECONDARY TO ACTINOMYCES NEUII

Abstract

SESSION TITLE: Monday Fellow Case Report Posters SESSION TYPE: Fellow Case Report Posters PRESENTED ON: 10/21/2019 02:30 PM - 03:15 PM INTRODUCTION: Actinomyces neuii is a gram-positive organism infrequently recognized and can cause a myriad of infections. To date, no infections have been described in the pleural space. We present a case of empyema secondary to A. neuii. CASE PRESENTATION: 74 year old woman presented with 2 months of dyspnea on exertion, 5 days of acute pleuritic chest pain, fever, and oxygen desaturation to 88% on room air as outpatient prompting hospitalization. She denied weight loss, had a history of hypothyroidism, remote history of removed left breast fibro-adenoma and quit smoking 40 years prior. She received antibiotics for an upper respiratory infection a month prior. She had a neutrophil predominant leukocytosis to 19.4 and elevated liver enzymes. Computed tomography of chest showed right hilar lymphadenopathy and loculated pleural effusion. She was admitted and started on broad spectrum antibiotics. A chest tube was placed yielding purulent drainage and fluid analysis revealed 85% neutrophils with lactate dehydrogenase of 1843 U/L indicating an exudate. She was treated according to the MIST II protocol for empyema. Further workup revealed negative respiratory viral, HIV, immunoglobulin and hepatitis panels. Blood culture grew gram positive rods 84 hours after admission in anaerobic media which speciated 2 weeks after as A. neuii. Pleural fluid cytopathology was negative for malignancy and culture, including acid fast bacilli. CT of her abdomen and pelvis was negative for intra-abdominal source of infection, but revealed fibroid uterus and an intrauterine device (IUD) without evidence of infection. She completed 4 weeks of Ceftriaxone followed by 4.5 months of Amoxicillin with resolution of leukocytosis, lymphadenopathy and complete resolution of pleural space on outpatient interval imaging. DISCUSSION: A. neuii is an aerobic and facultative anaerobic organism that does not produce sulfur granules or branching filaments. It can cause soft tissue abscesses especially surrounding foreign bodies, post intravitreal injection endopthalmitis, and 2 cases of neonatal sepsis that resulted in premature delivery. One mother had emergent placement of cervical cerclage while the other had prolonged use of IUD. A. neuii is susceptible to beta-lactam antibiotics, clindamycin and erythromycin. Fluoroquinolones and trimethoprim-sulfamethoxazole have less in-vitro activity against isolates. Surgical resection is usually indicated for soft tissue infections. Though inconclusive, the preceding respiratory infection or the prolonged use of IUD may have been sources for infection. We suspect A. neuii was the causative organism for the empyema despite the fact that it was only cultured from blood and not from the pleural space. CONCLUSIONS: To date, no cases of empyema due to A. neuii have been reported in literature. We describe a case with successful non-surgical management. Reference #1: 1. Zelyas N, Gee S, Nilsson B, Bennett T, Rennie R. Infections Caused by Actinomyces neuii: A Case Series and Review of an Unusual Bacterim. Can J Infect Dis Med Mircobiol. 2016;2016:6017605 Reference #2: 2. Olson JM, Vary JC Jr. Primary Cutaneous Actinomyces neuii Infection of the Breast Successfully Treated with Doxycycline. Cutis 2013;92(16)E3-4 Reference #3: 5. Alsohime F, Assiri RA, Al-Shahrani F, Bakeet H, Elhazmmi M, Somily AM. Premature labor and neonatal sepsis caused by Actinomyces neuii. J Infect Public Health 2018 S1876-0341(18)30037-6 DISCLOSURES: no disclosure on file for Stella Hahn; no disclosure on file for Gita Lisker; No relevant relationships by Etieno Umobong, source=Web Response