Chest Infections: Student/Resident Case Report Poster - Chest Infections I |

A Case of Serratia Lung Abscess in a Patient With Accessory Cardiac Bronchus FREE TO VIEW

Ayoub Innabi, MD; Mai Altous, MD; Bashar Alzghoul, MD; Kshitij Chatterjee, MD; Nikhil Meena, MD; Feras Hawari, MD
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University of Arkansas for Medical Sciences, Little Rock, AR

Copyright 2016, American College of Chest Physicians. All Rights Reserved.

Chest. 2016;150(4_S):176A. doi:10.1016/j.chest.2016.08.185
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SESSION TITLE: Student/Resident Case Report Poster - Chest Infections I

SESSION TYPE: Student/Resident Case Report Poster

PRESENTED ON: Tuesday, October 25, 2016 at 01:30 PM - 02:30 PM

INTRODUCTION: Infections by Serratia marcescens are usually associated with immunosuppression or other serious medical comorbidities and are otherwise rarely seen (1). We present a previously healthy woman with Serratia lung abscess in close proximity with an accessory cardiac bronchus.

CASE PRESENTATION: A 64- year- old previously healthy woman, presented with fever and mild hemoptysis of two weeks’ duration. She had received a course of Azithromycin prior to presentation without benefit. Her physical exam was unremarkable. Laboratory workup was normal except for a mildly elevated C-reactive protein (22.4 mg/l). Computed tomography (CT) of chest with contrast was performed which revealed a 3.2x3.5 cm lobulated mass with hypo-attenuated center and thick peripheral contrast enhancement in the medial aspect of the superior segment of right lower lobe (figure 1). The mass had a communication to the bronchus intermedius by a small accessory bronchus arising from the medial wall. The accessory bronchus extended medially with distal tapering compatible with cardiac bronchus (figure 1). Bronchoscopy revealed an obstruction of the right medial basilar segment orifice. Endobronchial brush and biopsy samples were normal. EBUS (Endo Bronchial Ultrasound) fine needle aspirate showed numerous acute inflammatory cells. BAL (Broncho-alveolar Lavage) culture grew Serratia marcescens. She was treated with intravenous Ertapenem for 2 weeks followed by oral levofloxacin for 2 weeks, with significant clinical improvement. A Follow up chest CT a month later showed near complete resolution of the abscess (figure 2). She has had no recurrence since this presentation.

DISCUSSION: Serratia lung abscess is usually reported in patients with serious comorbidities or with some degree of immunosuppression. When identified in an apparently healthy host it warrants a work up for the inciting event, like the discovery of accessory cardiac bronchus in our case. Briefly, cardiac bronchii are a rare variant found in 0.07-0.5% of the population and can be associated with recurrent infections and mild hemoptysis (2).

CONCLUSIONS: This report describes a rare case of a community acquired Serratia lung abscess in an immunocompetent patient likely due to the presence of the cardiac bronchus. Serratia marcescens should be a differential for lung abscess.

Reference #1: Mahlen SD. Serratia infections: from military experiments to current practice. Clinical microbiology reviews. 2011;24(4):755-91.

Reference #2: Barreiro TJ, Gemmel D. Accessory cardiac bronchus. Lung. 2014;192(5):821-2.

DISCLOSURE: The following authors have nothing to disclose: Ayoub Innabi, Mai Altous, Bashar Alzghoul, Kshitij Chatterjee, Nikhil Meena, Feras Hawari

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