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Lung Pathology |

Knitting Pneumonia?

Biplab Saha, MD; Sunil Sapru, MD; Kristin Fless, MD
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Saint Barnabas Medical Center, West Orange, NJ


Chest. 2015;148(4_MeetingAbstracts):622A. doi:10.1378/chest.2271650
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Abstract

SESSION TITLE: Lung Pathology Student/Resident Case Report Posters

SESSION TYPE: Student/Resident Case Report Poster

PRESENTED ON: Tuesday, October 27, 2015 at 01:30 PM - 02:30 PM

INTRODUCTION: Pantoea agglomerans (P agglomerans),a member of the enterobacteriaceae family, is a facultative anaerobic organism frequently found in the soil and on plants.It is an emerging human pathogen that causes localized infection , ventilator associated pneumonia (VAP), as well as primary and catheter related blood stream infection (CRBSI), especially in immunocompromised patients.We report a case of community acquired pneumonia (CAP) from P agglomerans.

CASE PRESENTATION: A 70 year old female with gastroesophageal reflux disorder (GERD) presented with dry cough for 6 months. She had been treated for an upper respiratory tract infection that resolved but the cough lingered on. She denied any fever, chest pain,shortness of breath, sputum production, hemoptysis, night sweats or any sick contacts. Her hobbies included knitting. Physical examination was significant for bilateral coarse breath sounds with mild diffuse expiratory wheezing. CBC, CMP were unremarkable.TB quantiferon gold test was negative.Chest X-ray showed left basal atelectasis. Pulmonary function tests demonstrated mild reduction in end expiratory flow with moderate reduction in gas exchange.CT scan demonstrated multifocal areas of consolidation.Echocardiography was normal. She was treated with cough suppressants and inhaled albuterol. She continued to have cough and CT scan after 3 months showed persistent diffuse bilateral consolidation with airbronchograms. Bronchoscopy was unremarkable and bronchoalveolar lavage showed normal bronchial cells on the background of inflammatory cells. The culture was positive for P agglomerans. She was treated with levofloxacin that resulted in complete resolution of cough. Repeat CT scan showed significant improvement.

DISCUSSION: P agglomerans has been implicated as the causative organism for skin and soft tissue infection, septic arthritis,endopthalmitis, peritonitis, VAP and CRBSI. It is most common in debilitated patients, including patients with cancer and immunocompromised states. Other risk factors include GERD and use of antacid and steroids. Transmission through food is a possibility.Lack of acidity in the stomach due to antacid use might make the host more susceptible. In the past, cotton was suspected as the source of infection and a few cases of blood stream infection have been reported in intravenous drug users. To our knowledge, CAP due to P agglomerans has never been reported before. Whether knitting with exposure to cotton put this patient at increased risk for P agglomerans infection is an interesting possibility.

CONCLUSIONS: P agglomeransis an emerging pathogen of relatively low virulence and may be involved in unusual infections presenting both in immunocompetent and immunocompromised patients.Fortunately, treatment with antibiotics for gram negative organismsis is usually curative.

Reference #1: Uche A. Pantoea agglomerans bacteremia in a 65-year-old man with acute myeloid leukemia: case report and review. South Med J 2008;101:102e3.

DISCLOSURE: The following authors have nothing to disclose: Biplab Saha, Sunil Sapru, Kristin Fless

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