SESSION TYPE: Infectious Disease Student/Resident Case Report Posters I
PRESENTED ON: Tuesday, October 23, 2012 at 01:30 PM - 02:30 PM
INTRODUCTION: Non-typhi Salmonella normally presents as a bacteremia, enterocolitis, and endovascular infection but rarely manifests as pleuropulmonary disease(1). We present a case of a unilateral pleural empyema caused by group D Salmonella.
CASE PRESENTATION: A 66-year-old Hispanic female was admitted with a 3-day history of pleuritic left-sided chest pain associated with dyspnea on exertion. She denied any fever, cough or recent gastrointestinal symptoms. Her past medical history was significant for hypertension, diabetes mellitus(type II), coronary artery disease, and a 20-pack-year smoking history. Physical exam revealed stable vital signs. Respiratory examination was remarkable for dullness to percussion with decreased breath sounds over the left lung base, but no rales or rhonchi were appreciated. The remainder of the physical examination was unremarkable. Initial laboratory findings were significant for WBC 11,800/mm3 with 84% neutrophils and 9% lymphocytes, BUN 41, and Cr 2.00. Chest x-ray showed opacification of the lower two-thirds of the left hemithorax. Chest CT scanning showed a large left pleural effusion that was partially loculated. A thoracocentesis was subsequently performed and pleural fluid analysis showed: glucose 92, LDH 292, total protein 4.0, WBC 1033, along with gram-negative cocci bacilli. The pleural fluid was consistent with an exudative effusion according to Lights’ criteria. Vancomycin and Cefepime were initiated and a chest tube was placed for drainage. The following day, pleural fluid cultures grew Salmonella group D. Blood cultures were all negative for any bacterial growth. The patient underwent decortications of the lung due to loculation of the effusion. Four days thereafter the patient’s symptoms resolved and she was discharged on oral Ciprofloxacin.
DISCUSSION: In the absence of concurrent pulmonary infection, a pleural empyema caused by non-typhoid Salmonella is rare, with only 16 cases reported to date. The incidence of developing non-typhi Salmonella appears highest among the immunocompromised and those who have hemoglobinopathies(2,3). In patients with pleuropulmonary non-typhi Salmonella infection, 40% of patients have been identified with having prior lung pathology(3).
CONCLUSIONS: Salmonella D is a non-typhoid serotype of Salmonella and is an unusual cause of pleuropulmonary infections; however, as our case demonstrates, non-typhi Salmonella should be included in the differential as a causative agent.
1) Aguado,J.M., Obeso,G., Cabanillas,J.J., Fernández-Guerrero,M., Alés,J.(1990) Pleuropulmonary infections due to nontyphoid strains of Salmonella. Arch Intern Med.150(1),54-6.
2) Ridha,A.G., Malbrain,M.L., Mareels,J., Verbraeken,H., Zachee,P.(1996) Lung abscess due to non-typhoid Salmonella in an immunocompromised host. Acta Clin Belgi.51,175-83.
3) Crum,N.F.(2005) Non-typhi Salmonella empyema: case report and review of the literature. Scand J Infect Dis.37,852-7.
DISCLOSURE: The following authors have nothing to disclose: Jennifer Kam, Vikram Doraiswamy, Sami Abdul Jawad, Yazan Abdeen, Chintan Modi, Robert Spira, Marc Adelman, Richard Miller
No Product/Research Disclosure InformationSeton Hall University School of Graduate Medical Education; St. Michael's Medical Center, Newark, NJ