SHM Converge Scientific Abstract ePoster Gallery-Neisseria Sicca Empyema in a Patient With Isolated Ige Deficiency

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An 18-year-old previously healthy male developed acute left-sided chest pain, shortness of breath, and night sweats, and was found to have a loculated left pleural effusion with compressive atelectasis. After failing outpatient doxycycline, he was transferred for higher-level care, treated with chest tube drainage, empiric ceftriaxone and metronidazole, and ultimately underwent VATS decortication. Pleural fluid and pleural rind cultures grew <strong>Neisseria sicca</strong>, an unusual non-meningococcal, non-gonococcal Neisseria species.

Because the organism was atypical, an immunologic evaluation was performed. CH50, IgA, IgM, and IgG were normal, but <strong>IgE was undetectable</strong>, revealing an <strong>isolated IgE deficiency</strong>. Infectious disease recommended stopping metronidazole, continuing ceftriaxone inpatient, and completing therapy with <strong>amoxicillin-clavulanate</strong> after discharge. The patient improved clinically and was discharged on hospital day seven to complete a three-week antibiotic course, with outpatient immunology follow-up advised.

The report emphasizes that non-meningococcal Neisseria species rarely cause disease, but <strong>N. sicca</strong> has previously been associated with infection in immunodeficient hosts. This case is presented as, to the authors’ knowledge, the <strong>first reported empyema caused by a non-meningococcal/non-gonococcal Neisseria species in a patient with selective IgE deficiency</strong>. The authors suggest that IgE may play a more important role in protection against bacterial infection than previously appreciated. They recommend considering immune deficiency work-up in otherwise healthy patients with empyema caused by unusual organisms and recognizing isolated IgE deficiency as a possible contributor to opportunistic infection risk.

Asset Subtitle

John C. Weis

Meta Tag

Author List John C. Weis, Matthew Wilson, Philip Y. Chang, Zachary Smith

Category Clinical Vignettes

Concept Atypical Neisseria

Concept Empyema

Concept Immune Defect

Concept Selective IgE Deficiency

Concept Immunologic Evaluation

Distinguished Non-Finalist

Presenter Organization Ohio University Heritage College of Osteopathic Medicine - Dublin

Presenting Author John C. Weis

Track Adult

Keywords

Neisseria sicca

empyema

isolated IgE deficiency

selective IgE deficiency

pleural effusion

VATS decortication

non-meningococcal Neisseria

non-gonococcal Neisseria

immunodeficiency

amoxicillin-clavulanate

Atypical Neisseria

Empyema

Immune Defect

Selective IgE Deficiency

Immunologic Evaluation