Davis Brittany, Ashkin Alex, Fisher Gairman, Plowman Keegan, Valle Jose
Naples Community Hospital, Naples, FL, United States.
NCH GME Office, Naples, FL, United States.
Respir Med Case Rep. 2024 Sep 27;52:102125. doi: 10.1016/j.rmcr.2024.102125. eCollection 2024.
Salmonella infections usually present as self-limiting gastrointestinal illnesses. Salmonella pneumonia is an uncommon infection that should be considered in immunodeficient individuals originally presenting with enterocolitis. With fewer than 40 reported cases, salmonella pneumonia can rarely lead to empyema (1. Abdelhafiz, 2020).This case report highlights an unusual presentation of a focal metastatic salmonella pneumonia complicated by an empyema in an immunocompromised host.
An elderly Hispanic gentlemen with history of end stage liver disease, hepatocellular carcinoma, diabetes mellitus type 2, and malnutrition presents with left upper extremity weakness along with four days of generalized weakness, diarrhea, nausea and vomiting. He later developed cough and leukocytosis. Chest X-ray revealed a right sided diaphragmatic hernia. He subsequently had an episode of hemoptysis which led to further imaging. CT Chest revealed a 14 cm loculated right lower lung pleural air fluid filled collection. Thoracentesis with pleural fluid analysis revealed a 200 mL of frank pus, lactate dehydrogenase of 22,182 U/L, protein 3.2 g/dL, WBC 295,503/mm^3, RBC 34,583/mm^3.Cultures revealed a non-typhi Salmonella species. Patient was started on Piperacillin-tazobactam. Infectious disease, pulmonary and cardiothoracic surgery were consulted to ensure interdisciplinary treatment strategy and optimize patient outcome. Treatment course was complicated by inadvertent chest tube dislodgment. Cardiothoracic surgery decided against surgical intervention. Patient was subsequently transitioned to oral levofloxacin with 2 month treatment course as well as regular follow up with pulmonology and infectious disease. Repeat Chest CT after antibiotic treatment was remarkable for a 6.6 cm right lower lobe abscess.
沙门氏菌感染通常表现为自限性胃肠道疾病。沙门氏菌肺炎是一种罕见的感染，对于最初表现为小肠结肠炎的免疫功能低下个体应予以考虑。沙门氏菌肺炎报告病例少于40例，很少会导致脓胸（阿卜杜勒哈菲兹，2020年）。本病例报告强调了一名免疫功能低下宿主中局灶性转移性沙门氏菌肺炎并发脓胸的不寻常表现。
一名患有终末期肝病、肝细胞癌、2型糖尿病和营养不良病史的老年西班牙裔男性，出现左上肢无力，伴有四天的全身无力、腹泻、恶心和呕吐。他后来出现咳嗽和白细胞增多。胸部X光显示右侧膈疝。随后他发生了咯血，这导致了进一步的影像学检查。胸部CT显示右肺下叶有一个14厘米的局限性胸膜气液积聚。胸腔穿刺及胸水分析显示有200毫升脓性液体，乳酸脱氢酶为22,182 U/L，蛋白3.2 g/dL，白细胞295,503/mm³，红细胞34,583/mm³。培养显示为非伤寒沙门氏菌。患者开始使用哌拉西林-他唑巴坦。咨询了传染病科、胸科和心胸外科，以确保采取跨学科治疗策略并优化患者预后。治疗过程因胸管意外脱落而复杂化。心胸外科决定不进行手术干预。患者随后改用口服左氧氟沙星，疗程为2个月，并定期接受肺病科和传染病科的随访。抗生素治疗后复查胸部CT显示右肺下叶有一个6.6厘米的脓肿。
