Chest Infections |

Pulmonary Nodules Associated With Gemella Species in Ulcerative Colitis Patient Under Treatment With Mercaptopurine FREE TO VIEW

Ayham Deeb*, MD; Manuel Bautista, MD; Ritha Kartan, MD; Salim Abou Jaoude, MD
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Western Reserve Health Education, Youngstown, OH

Chest. 2012;142(4_MeetingAbstracts):257A. doi:10.1378/chest.1390516
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SESSION TYPE: Infectious Disease Student/Resident Case Report Posters II

PRESENTED ON: Tuesday, October 23, 2012 at 01:30 PM - 02:30 PM

INTRODUCTION: One interesting aspect of lung infections is the wide variety of findings we encounter, especially in immune compromised patients. We present an interesting case of Gemella species infection in ulcerative colitis patient that appeared as lung nodules on the chest CT scan.

CASE PRESENTATION: A 62 year old female presented with a history of ulcerative colitis that had recently flared up and was treated by adding a tapering dose of steroids to Mercaptopurine she was on for a year. A 60 mg dose of oral Prednisone helped her symptoms initially, but on approaching 20 mg she presented to our hospital with a recurrent complaint of cramping abdominal pain and bloody diarrhea in addition to new onset dyspnea and dry cough. She mentioned chills but denied fever, recent travel or sick contact. She smoked for 8 years when she was younger. On physical exam her blood pressure was 123/60 mmHg, pulse 69beats/min, respirations 18/min, temperature 97.7 F and saturation 98% on room air. Her oral mucosa was moist without pharyngeal erythema or ulcerations, she did not have labored respirations, and her lungs sounded clear. She did not have peripheral edema, any organomegaly or adenopathy. Because of normal chest X- rays on admission and suspicion of atypical organism we performed a bronchoscopy with biopsies and cultures. The only positive tests were the bronchial cultures and biopsies which revealed Gemella species growth. Subsequent chest CAT scan demonstrated right upper and lower lobe nodules. After starting Amoxicillin/ Clavulanate 875/125 mg for 14 days she had clinical improvement on the days before discharge and on the follow up visit after one month. This patient had normal PET scan after 6 months.

DISCUSSION: Gemella species are Gram-positive cocci in pairs and short chains, the members of this genus are inhabitants of the oral cavity and upper respiratory tract that can be pathogenic. Lung involvement by Gemella species has been reported in situations of immune -compromise or malignancy (Leukemia, Sarcoma). There are also miscellaneous radiologic findings including clear images, necrotizing or interstitial infiltrations, or nodules. Clinical improvement is usually expected after 2 weeks treatment by the appropriate antibiotics.

CONCLUSIONS: Infectious reason should be considered as the underlying cause of lung nodules especially in immune compromised patients and in some malignancies. In cases of malignancy these nodules should be differentiated from metastatic lesions, and for that clinical and radiologic follow up is very important after treatment with antibiotics that cover Gemella species.

1) Pulmonary nodules associated with Gemella bacteremia: CT findings in two children with osteosarcoma. Blitman NM, Steiner AM, Bell MD, Wilks-Gallo L. J Thorac Imaging. 2007 May;22(2):182-4.

2) Empyema thoracis and lung abscess due to Gemella morbillorum. da Costa CT, Porter C, Parry K, Morris A, Quoraishi AH. Eur J Clin Microbiol Infect Dis. 1996 Jan;15(1):75-7.

DISCLOSURE: The following authors have nothing to disclose: Ayham Deeb, Manuel Bautista, Ritha Kartan, Salim Abou Jaoude

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Western Reserve Health Education, Youngstown, OH




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