NONTYPHOIDAL SALMONELLA EMPYEMA AS A COMPLICATION OF PRIMARY SALMONELLA ENTERITIDIS BACTEREMIA

Abstract

TYPE: Abstract Publication TOPIC: Chest Infections PURPOSE: We present a case of Salmonella enteritidis empyema and bacteremia in the absence of enteric infection or known immunological dysfunction. METHODS: Clinical care and chart review of single patient. RESULTS: A 60-year-old female presented for evaluation of fever and dyspnea. She was febrile, tachycardic, and tachypneic. Chest X-ray revealed complete opacification of the left hemithorax [Figure 1 – panel A]. CT angiogram of the chest showed a large loculated left pleural effusion causing collapse of the left hemithorax [Figure 1 – panel B]. Blood cultures grew Salmonella enteritidis and the patient was treated for severe sepsis. Ultrasound-guided thoracentesis was performed and revealed frank pus consistent with acute suppurative empyema; pleural fluid cultures also grew Salmonella enteritidis. The patient underwent video-assisted thoracoscopic surgery with purulent fluid drainage and insertion of a chest tube. Despite aggressive medical treatment, she continued to deteriorate requiring transfer to the intensive care unit due to septic shock. Due to her exceptionally poor prognosis, the patient’s family ultimately elected to pursue comfort measures. CONCLUSIONS: Extraintestinal Salmonella infection due to primary bacteremia is exceedingly rare. Often, this can indicate underlying immunologic dysfunction due to HIV infection, malignancy, etc. In addition to prolonged antimicrobial therapy, surgical drainage or debridement is generally required, as with our case of empyema. CLINICAL IMPLICATIONS: A high index of suspicion is critical to early recognition, which can be difficult in non-endemic regions, particularly in the absence of enteric infection or underlying immunodeficiency. Despite our patient’s demise, early appropriate antibiotics and timely surgical intervention are crucial to improve future outcomes. DISCLOSURE: No significant relationships. KEYWORDS: Salmonella enteritidis, Empyema, VATS