Gemella Morbillorum: A Rare Cause of Empyema Necessitans

Abstract

SESSION TITLE: Lung Infections 2 SESSION TYPE: Affiliate Case Report Slide PRESENTED ON: Monday, October 30, 2017 at 11:00 AM - 12:00 PM INTRODUCTION: Empyema necessitans is a rare condition that arises when pus from the pleural cavity penetrates through the adjacent tissues to form a chest wall abscess. It can occur in the setting of delayed treatment of pleural infections. We present a case of empyema necessitans as a result of suspected chest wall trauma. CASE PRESENTATION: A 59 year old female was referred to the hospital by her pulmonologist after an incidental finding of a right lower lobe pulmonary embolism, right chest wall hematoma, and a right upper lung effusion on computed tomography (CT) scan of the chest. One month prior she had suffered a fall and developed progressively worsening dyspnea. She denied any fevers, chills, chest wall swelling, pain, or skin abrasions. Prior to the initiation of anticoagulation, a thoracentesis was performed to rule out a hemothorax. Imaging also noted a communication between the pleural effusion and a collection in the anterior chest wall. Thick purulent material was noted on CT guided thoracentesis and drainage of the chest wall abscess. A chest tube was placed in the pleura and a pig tail drain in the chest wall. The patient was empirically started on piperacillin-tazobactam. Microbiological studies from the pleural fluid and thoracic abscess were positive for Gemella morbillorum. The chest tube and pig tail drain were removed after 4 days when resolution of the empyema and chest wall abscess were noted. The patients dyspnea resolved and the patient was discharged on a 14 day course of Doxycycline. DISCUSSION: On review of the literature, most reported cases of empyema necessitans were caused by Mycobacterium tuberculosis, Actinomyces israelii, Streptococcus pneumoniae, Staphylococcus aureus, and Pseudomonas cepacia. Gemella morbillorum is a Gram-positive coccus which naturally inhabits the human oropharyngeal, gastrointestinal, and urogenital flora. However, it is infrequently isolated and rarely results in pleural infections. Additionally, chest wall trauma is a rarely reported inciting factor for an empyema necessitans. CONCLUSIONS: Our case highlights a rare occurrence where Gemella morbillorum was the causative agent of an empyma necessitans secondary to chest wall trauma. This brings to light that rare causes must be considered in the investigation of an empyema necissitans. Reference #1: Kono S, Nauser T. Contemporany empyema necessitatis. Am J Med. 2007;120:303-5. Reference #2: Benedetti P, Rassu M, Branscombe M, Sefton A, Pellizzer G. J. Med. Microbiol. 58(12):1652-1656 doi:10.1099/jmm.0.013367-0 DISCLOSURE: The following authors have nothing to disclose: Sohi Ashraf, Animesh Gour, Santhosh John, Shalinee Chawla No Product/Research Disclosure Information