SALMONELLA LUNG ABSCESS IN AN IMMUNOCOMPETENT PATIENT

Abstract

SESSION TITLE: Late-breaking Abstract Posters SESSION TYPE: Original Investigation Posters PRESENTED ON: October 18-21, 2020 PURPOSE: Non typhoidal salmonella (NTS) usually causes self-limiting gastroenteritis. Rarely it can cause invasive infections in adults with specific risk factors. We report a case of a multiple lung and paracardiac abscesses caused by NTS in an immunocompetent patient METHODS: A 66-year-old Qatari lady with Diabetes Mellitus, Hypertension and End Stage Renal Disease came for her regular hemodialysis session. She had an abnormal chest X-ray which was done for her history of cough with minimal amount of whitish sputum for the preceding four weeks. She denied any history of fever, chest pain, shortness of breath or weight loss. She did not recollect any recent or remote history of gastrointestinal symptoms. On examination, she was comfortable at rest with normal vital signs. Her chest auscultation revealed decreased breath sounds in the right infra scapular area. Blood tests were significant for leukocytosis of 12,700/mm3 with 75% neutrophils and elevated inflammatory markers with CRP of 137 mg/dl. Chest X-ray showed cavitary lesions with multiple air fluid levels in the right hemithorax silhouetting the right heart border and right hemidiaphragm with mild pleural effusion. This was confirmed on CT scan of the chest as multiple cavitary lesions containing air and fluid in right lower and middle lobe with largest one measuring 5.5 x 4.2 cm and a similar right pericardial cavitary lesion along the right heart border measuring 8.5 x 6.2 cm. Septic work up including sputum culture and two sets of blood cultures were negative RESULTS: She underwent bronchoscopy which revealed normal anatomy. The bronchoalveolar lavage (BAL) from right middle and lower lobe cultured Salmonella species type D which was sensitive to Ceftriaxone. Tuberculosis work up from the induced sputum and BAL was negative. She was started on parenteral Ceftriaxone 2 gm once daily with improvement in leukocytosis and in inflammatory markers. She was discharged on parenteral Ceftriaxone for a total of 2 weeks duration with follow up arranged in clinic to assess for clinical and radiological improvement. CONCLUSIONS: Extraintestinal Salmonellosis is uncommon and pulmonary involvement accounts for only 10% of this. Pulmonary manifestations are likely in immunocompromised patients and usually occur due to hematogenous spread which can be transient leading to negative blood cultures in 25%-45% of the cases as in our patient. Most common presentation is Salmonella pneumonia. Lung abscess is rare with less than 10 cases of Salmonella lung abscess reported in the literature to our knowledge in an immunocompetent host. Duration of antimicrobial treatment is not well defined with minimum of two weeks and to be extended until resolution of abscess with a success rate of 80% - 90%. Surgical drainage is considered an adjunct option CLINICAL IMPLICATIONS: This case highlights NTS as a potential causative agent for lung abscess even in immunocompetent host. DISCLOSURES: No relevant relationships by Raza Akbar, source=Web Response No relevant relationships by Elrazi Awadelkarim Ali, source=Web Response No relevant relationships by Fatma Ben Abid, source=Web Response No relevant relationships by Shanima Ismail, source=Web Response No relevant relationships by Almurtada Razok, source=Web Response No relevant relationships by Merlin Thomas, source=Web Response No relevant relationships by Godwin Wilson, source=Web Response