Fever and pleurodynia after dental appointment in a 65-year-old male

Abstract

We present a unique case of parapneumonic effusion from an unusual microorganism on a 65-year-old ex-smoker with a history of arterial hypertension and diabetes mellitus, following dental procedures for a periapical tooth abscess. Cultures from the dental abscess were taken, coming back negative. However, some days after the procedure, fever and pleurodynia started showing up on the patient with his condition progressively worsening, until he visited the emergency room of the hospital. Laboratory exams and imaging were consistent with a complicated pneumonia with parapneumonic effusion. After ultrasound-guided evacuation of the effusion, Parvimonas micra (P. micra) was isolated from pleural fluid cultures, so antibiotics were accordingly modified on the treatment plan. The patient responded well, and clinical and radiological improvements were observed. This case highlights the rare occurrence of P. micra-associated pleuropulmonary infection, because of the difficulty to be isolated in the aerobic environment of the lungs, and underscores the importance of considering dental procedures as a potential source of such infections. Early diagnosis and appropriate antibiotic therapy, guided by culture and sensitivity testing, are essential for successful management.