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• W4387249617 abstract "SESSION TITLE: Chest Infections Case Report Posters 22 SESSION TYPE: Case Report Posters PRESENTED ON: 10/10/2023 09:40 am - 10:25 am INTRODUCTION: Parvimonas micra is a gram-positive anaerobic bacterium typically found in the oral cavity and GI tract as a commensal. Although it is commonly associated with infections related to periodontal and intra-abdominal areas, there have been an increasing number of reported cases involving infections outside of these areas. We describe a case of a patient who had recently undergone dental procedure, developing COVID-19 pneumonia complicated with P. micra empyema. CASE PRESENTATION: A 51-year-old man presented with right-sided pleuritic chest pain with dyspnea and productive cough of 2 weeks without fever or chills. He was hypoxic requiring supplemental oxygen via nasal cannula on presentation with reduced breath sounds in right lung with rhonchi and rales bilaterally. COVID nasal PCR was positive and chest X-ray with right lower lung field opacities. He was diagnosed with COVID 19 pneumonia with superimposed bacterial pneumonia, initiated on Remdesivir and Dexamethasone for COVID-19, Ceftriaxone & Azithromycin for bacterial infection. On the 3rd day, he deteriorated with worsening hypoxia requiring non-invasive ventilator support. A repeat chest X-ray showed right sided pneumothorax with worsening consolidation and effusion, CT chest showed right hydropneumothorax with compressive atelectasis, consolidation of right middle and lower lobes. Leukocytosis worsened from 29 to 67 (x10^3 /mcL). Chest tube was placed with alteplase instillation into right pleural space. He subsequently underwent thoracotomy with total lung decortication, pneumolysis and wedge section of right middle and lower lobe. Exudative fluid yielded WBC count of 1350 cells/µL with 98% neutrophils and culture grew Parvimonas micra. Patient's antibiotic coverage was broadened to vancomycin, piperacillin-tazobactam, and levofloxacin and managed in the ICU following surgical procedure. He required vasopressors for septic shock while in ICU. Patient subsequently improved, was extubated and discharged home with oral antibiotics. DISCUSSION: Empiric antibiotics like ceftriaxone and azithromycin are commonly used to treat community acquired pneumonia, however when patients do not respond to empiric therapy or show signs of deterioration, anaerobes should be considered and coverage should be broadened. Patients with recent dental work like our patient are at risk for anaerobic bacterial involvement. Failure to consider low-prevalence bacteria as causative agents can result in poor outcomes. CONCLUSIONS: Parvimonas micra is a normal flora in oral cavity and gastrointestinal tract is associated with polymicrobial infections involving these areas. Review of literature revealed only about 30 reported cases of P. micra being the sole pathogen causing infections outside of GI tract and oral cavity, such as vertebral abscesses, bacteremia, and septic arthritis.(1) Cases involving the pleural cavity are very low, and there is only one other reported case of P. micra causing empyema in a patient with influenza A.(2) We report the first case of empyema with P. micra complicating COVID-19 pneumonia. It is important to recognize P. micra as an emerging pathogen and not disregard its identification in culture as a contaminant. Ignoring this may result in a poor outcome and should be treated appropriately. REFERENCE #1: Cobo F, Rodríguez-Granger J, Sampedro A, Aliaga-Martínez L, Navarro-Marí JM. Pleural effusion due to Parvimonas micra. A case report and a literature review of 30 cases. Rev Esp Quimioter. 2017;30(4):285-292. REFERENCE #2: Padappayil RP, Shah DJ, Shah K. When flu leads the way: A case of Parvimonas Micra polymicrobial empyema in a patient with Influenza A infection. Chest. 2022;162(4):A1435. doi:10.1016/j.chest.2022.08.1206 DISCLOSURES: No relevant relationships by Neema Jayachamarajapura Onkaramurthy No relevant relationships by SAPANA JHA No relevant relationships by Yone Lwin No relevant relationships by Vel Sivapalan No relevant relationships by Phone Pyae Win" @default.
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• W4387249617 date "2023-10-01" @default.
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• W4387249617 title "COVID-19 PNEUMONIA AS A TRIGGER FOR PATHOGENICITY OF AN USUAL ORAL COMMENSAL LEADING TO EMPYEMA" @default.
• W4387249617 doi "https://doi.org/10.1016/j.chest.2023.07.950" @default.
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