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• W4387249616 abstract "SESSION TITLE: Chest Infections Case Report Posters 36 SESSION TYPE: Case Report Posters PRESENTED ON: 10/11/2023 12:00 pm - 12:45 pm INTRODUCTION: Multiorgan cavitary lesions are concerning for infectious etiology. However, when culture data are inconclusive, diagnosis and treatment become insurmountable. This case highlights the challenges seen with invasive Fusobacterium nucleatum (F. nucleatum). CASE PRESENTATION: A 47-year-old man without prior medical history presented with three days of unilateral blindness, two months of cough, hemoptysis, and weight loss. He had uncomplicated COVID two months prior and recent travel to Jamaica and Arizona. He was afebrile, normal respirations, and heart rate of 109. On exam he had left hemianopsia, expressive aphasia, and clear pulmonary exam. He had a leukocytosis of 15, and magnetic resonance imaging of the brain revealed multiple bilateral ring enhancing lesions. Chest computed tomography showed a cavitary lesion with ground glass opacities in the right upper lobe. Workup including coccidiosis, histoplasma, cryptococcal, aspergillus antigen, blood, fungal and respiratory cultures, acid fast stain, lumbar puncture with cytology, bronchoalveolar lavage, pulmonary biopsy, and transthoracic echocardiogram was unrevealing. He received empiric ceftriaxone, vancomycin, and metronidazole, however due to a drug rash on day 10 he transitioned to imipenem, bactrim, linezolid, and amphotericin B, with later addition of voriconazole on day 19 after noted extension of lesions on imaging. Ultimately, he underwent a craniotomy and the abscess aspirate grew F. nucleatum. An attempt was made to narrow to ceftriaxone, resulting in another drug reaction. He was then transitioned to meropenem and completed a ten-week course with plans to continue levofloxacin and metronidazole pending resolution of the lesions. At one month follow up he had resolution of visual and language deficits, and decreased size of pulmonary and brain cavitary lesions on imaging. DISCUSSION: F. nucleatum, a common oral flora anaerobe, has been implicated in oral infections, Lemierre's disease, and multiorgan abscesses. Its well-developed virulence factors, notably FadA adhesin, can cause undetected and prolonged infection. Despite its incidence of less than 1 per 100,000, it should be considered when multiorgan abscesses are present regardless of present bacteremia. As in our case, the sensitivity of blood cultures can be poor when associated with abscesses, and PCR mediated amplification may be useful.A true cause for invasive F. nucleatum was never identified in our patient. Given his preceding COVID infection, it is possible this infection and associated lung damage provided a nidus for F. nucleatum to become pathogenic. Lastly, given the known association with colorectal cancer, follow up colonoscopy should be completed as this is a possible etiology. CONCLUSIONS: F. nucleatum is a predominant member of the oral microbiota, and should be considered in patients with multiorgan abscesses with progressive disease despite negative blood culture. REFERENCE #1: Afra, K., Laupland, K., Leal, J., Lloyd, T., & Gregson, D. (2013). Incidence, risk factors, and outcomes of Fusobacterium species bacteremia. BMC infectious diseases, 13, 264. https://doi.org/10.1186/1471-2334-13-264 REFERENCE #2: Han YW. Fusobacterium nucleatum: a commensal-turned pathogen. Curr Opin Microbiol. 2015;23:141-147. doi:10.1016/j.mib.2014.11.013 REFERENCE #3: Chakvetadze C, Purcarea A, Pitsch A, Chelly J, Diamantis S. Detection of Fusobacterium nucleatum in culture-negative brain abscess by broad-spectrum bacterial 16S rRNA Gene PCR. IDCases. 2017;8:94-95. Published 2017 Apr 26. doi:10.1016/j.idcr.2017.04.013 DISCLOSURES: No relevant relationships by Jennifer Doran No relevant relationships by Sarah Shortall No relevant relationships by Ryan Turner" @default.
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• W4387249616 date "2023-10-01" @default.
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• W4387249616 title "MULTIORGAN CAVITARY LESIONS FROM FUSOBACTERIUM NUCLEATUM: A DIAGNOSTIC DILEMMA" @default.
• W4387249616 doi "https://doi.org/10.1016/j.chest.2023.07.1017" @default.
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