SALMONELLA ENTERITIDIS BACTEREMIA AND EMPYEMA FORMATION

Abstract

TOPIC: Chest Infections TYPE: Medical Student/Resident Case Reports INTRODUCTION: Nontyphoidal Salmonellae are anaerobic gram-negative bacilli that most commonly present with gastroenteritis but can cause extra-intestinal manifestations such as bacteremia, osteomyelitis, septic arthritis, endocarditis, endovascular infections, and abscesses. They have rarely been implicated in pulmonary infections. Here we describe a patient with chronic pleural effusions who had Salmonella enteritidis bacteremia and subsequent development of an empyema. CASE PRESENTATION: A 52 year-old male with history of chronic myelogenous leukemia (CML) who has been on dasatinib for the past 8 years, initially presented with fever, abdominal pain, and watery diarrhea. He was found to have Salmonella enteritidis bacteremia, improved with IV Ceftriaxone, and was discharged with a 10 day oral Cefdinir course. A CT abdomen/pelvis done during this admission was negative for intra-abdominal pathology but did note bilateral pleural effusions. He then presented one month later with cough, shortness of breath, and left-sided pleuritic chest pain. He was found to be hypoxic with labs significant for leukocytosis to 33 x10^9/L. CT chest revealed a large left pleural effusion with septations and pleural enhancement concerning for an empyema. Diagnostic thoracentesis was performed with drainage of purulent fluid and cultures subsequently growing Salmonella enteritidis. He underwent VATS which revealed a complex multiloculated empyema entrapping the entire left hemithorax, dense adhesions between the lung and the mediastinum, chest wall, and diaphragm, and a thick fibrous peel entrapping the left lung. Complete open decortication was performed, and a chest tube was placed. He improved clinically and was started on Ciprofloxacin for prolonged course. DISCUSSION: This patient initially presented with acute gastroenteritis due to Salmonella enteritidis, developed secondary bacteremia, and was treated with appropriate antibiotics. He later presented with dyspnea and cough with imaging concerning for a loculated pleural effusion and empyema. This was in the setting of chronic benign transudative pleural effusions likely secondary to his dasatinib therapy. This effusion was likely seeded when he was bacteremic, leading to development of an empyema. His history of malignancy and chronic lymphopenia likely also predisposed him to severe extraintestinal Salmonella infection given his impaired cellular immunity. CONCLUSIONS: Non-typhi Salmonella are not routinely associated with pleuropulmonary disease but can be a rare cause of empyema. REFERENCE #1: Acheson, D., & Hohmann, E. L. (2001). Nontyphoidal Salmonellosis. Clinical Infectious Diseases, 32(2), 263-269. https://doi.org/10.1086/318457 REFERENCE #2: Pathmanathan, S., Welagedara, S., Dorrington, P., & Sharma, S. (2015). Salmonella empyema: a case report. Pneumonia (Nathan Qld.), 6, 120–124. https://doi.org/10.1007/BF03371465 DISCLOSURES: No relevant relationships by Amy Amornmarn, source=Web Response No relevant relationships by Katherine Gershner, source=Web Response No relevant relationships by Almutasem Hamed, source=Web Response