Limits...
Clostridium septicum Empyema in an Immunocompetent Woman.

Granok AB, Mahon PA, Biesek GW - Case Rep Med (2010)

Bottom Line: We report a case of a Clostridium septicum empyema in an immunocompetent woman following operation for an incarcerated internal hernia.The patient was successfully treated with pleural decortication and an extended course of postoperative antibiotics.This is the first report of such an infection in the medical literature.

View Article: PubMed Central - PubMed

Affiliation: Infectious Disease Associates, 399 Daniel Webster Highway, Merrimack, NH 03054, USA.

ABSTRACT
We report a case of a Clostridium septicum empyema in an immunocompetent woman following operation for an incarcerated internal hernia. The patient was successfully treated with pleural decortication and an extended course of postoperative antibiotics. This is the first report of such an infection in the medical literature.

No MeSH data available.


Related in: MedlinePlus

Representative section from the patient's chest CT scan, performed during the second admission. Most of the right chest is taken up by multiple collections of fluid and gas. Note the leftward deviation of the mediastinal structures.
© Copyright Policy - open-access
Related In: Results  -  Collection


getmorefigures.php?uid=PMC2871551&req=5

fig4: Representative section from the patient's chest CT scan, performed during the second admission. Most of the right chest is taken up by multiple collections of fluid and gas. Note the leftward deviation of the mediastinal structures.

Mentions: The patient returned to the hospital 19 days later due to a complaint of worsening shortness of breath. Examination showed her to have a low-grade fever of 38°C and diminished breath sounds in the right chest. She had a white blood cell count of 24,500/mm3 with 18% band forms. The remainder of her CBC was normal. Her chemistries and electrolytes were unremarkable, except for a depressed albumin of 1.8 g/dL. Blood cultures were obtained and were negative. Her chest X-ray showed a right upper-lobe infiltrate with a large associated effusion (Figure 3). She was started on piperacillin/tazobactam and azithromycin, intravenously. Review of her chest X-ray suggested that she likely had several intrathoracic fluid collections. A CT scan of the chest was performed, demonstrating a large, multiloculated fluid collection in the right chest, with multiple air-fluid levels (Figure 4). There was a mass effect on the mediastinal structures. It could not be determined whether the fluid was contained above or below the diaphragm, so the patient was taken to the operating room, where an initial retroperitoneal approach showed that the fluid was in fact in the thoracic cavity. She then underwent thoracoscopy, which immediately encountered 1000 mL of thin, brown fluid and gas. Decortication was attempted via the thoracoscope, but ultimately was completed via open thoracotomy. Gram stain of the pleural fluid was negative, but anaerobic cultures yielded Clostridium septicum. The organism was identified using the RapID ANA II system (Remel Products, Lenexa, KS, USA). The organism did not produce β-lactamase. No additional susceptibility studies were performed. There was no growth in aerobic cultures. Her antibiotics were changed to aqueous penicillin G, 3 million units IV every four hours, and she was discharged home from the hospital on the sixth postoperative day to complete four weeks of parenteral antibiotic therapy at home. She made a full recovery, and a colonoscopy, performed to rule out a colonic neoplasm, was negative. She is still doing well, now over five years later.


Clostridium septicum Empyema in an Immunocompetent Woman.

Granok AB, Mahon PA, Biesek GW - Case Rep Med (2010)

Representative section from the patient's chest CT scan, performed during the second admission. Most of the right chest is taken up by multiple collections of fluid and gas. Note the leftward deviation of the mediastinal structures.
© Copyright Policy - open-access
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC2871551&req=5

fig4: Representative section from the patient's chest CT scan, performed during the second admission. Most of the right chest is taken up by multiple collections of fluid and gas. Note the leftward deviation of the mediastinal structures.
Mentions: The patient returned to the hospital 19 days later due to a complaint of worsening shortness of breath. Examination showed her to have a low-grade fever of 38°C and diminished breath sounds in the right chest. She had a white blood cell count of 24,500/mm3 with 18% band forms. The remainder of her CBC was normal. Her chemistries and electrolytes were unremarkable, except for a depressed albumin of 1.8 g/dL. Blood cultures were obtained and were negative. Her chest X-ray showed a right upper-lobe infiltrate with a large associated effusion (Figure 3). She was started on piperacillin/tazobactam and azithromycin, intravenously. Review of her chest X-ray suggested that she likely had several intrathoracic fluid collections. A CT scan of the chest was performed, demonstrating a large, multiloculated fluid collection in the right chest, with multiple air-fluid levels (Figure 4). There was a mass effect on the mediastinal structures. It could not be determined whether the fluid was contained above or below the diaphragm, so the patient was taken to the operating room, where an initial retroperitoneal approach showed that the fluid was in fact in the thoracic cavity. She then underwent thoracoscopy, which immediately encountered 1000 mL of thin, brown fluid and gas. Decortication was attempted via the thoracoscope, but ultimately was completed via open thoracotomy. Gram stain of the pleural fluid was negative, but anaerobic cultures yielded Clostridium septicum. The organism was identified using the RapID ANA II system (Remel Products, Lenexa, KS, USA). The organism did not produce β-lactamase. No additional susceptibility studies were performed. There was no growth in aerobic cultures. Her antibiotics were changed to aqueous penicillin G, 3 million units IV every four hours, and she was discharged home from the hospital on the sixth postoperative day to complete four weeks of parenteral antibiotic therapy at home. She made a full recovery, and a colonoscopy, performed to rule out a colonic neoplasm, was negative. She is still doing well, now over five years later.

Bottom Line: We report a case of a Clostridium septicum empyema in an immunocompetent woman following operation for an incarcerated internal hernia.The patient was successfully treated with pleural decortication and an extended course of postoperative antibiotics.This is the first report of such an infection in the medical literature.

View Article: PubMed Central - PubMed

Affiliation: Infectious Disease Associates, 399 Daniel Webster Highway, Merrimack, NH 03054, USA.

ABSTRACT
We report a case of a Clostridium septicum empyema in an immunocompetent woman following operation for an incarcerated internal hernia. The patient was successfully treated with pleural decortication and an extended course of postoperative antibiotics. This is the first report of such an infection in the medical literature.

No MeSH data available.


Related in: MedlinePlus