SHM Converge Scientific Abstract ePoster Gallery-When Anaerobes Strike: Fusobacteria as an Unexpected Cause of Empyema

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This case describes a 52-year-old man with hypertension, GERD, and prior COVID infection who developed persistent fever, dyspnea on exertion, night sweats, headache, and nausea after a recent episode of presumed multifocal pneumonia. Despite outpatient treatment with azithromycin, cefdinir, and prednisone, his symptoms worsened. He had left-sided chest pain, high fever, and imaging showing extensive left lower lobe consolidation with a large loculated pleural effusion, consistent with empyema.<br /><br />He was started on broad-spectrum antibiotics including vancomycin, cefepime, and metronidazole. Interventional pulmonary placed a chest tube, draining 400 mL of purulent pleural fluid. Pleural studies showed markedly inflammatory fluid, and cultures grew Fusobacterium nucleatum and Streptococcus anginosus. Additional workup for MRSA, AFB, HIV, HCV, and blood cultures was negative. He also received six doses of intrapleural dornase alfa to help break down loculations.<br /><br />By hospital day 5, he improved clinically and was transitioned to oral amoxicillin-clavulanate for a 6-week course. Follow-up CT showed significant reduction in the pleural effusion and improved left lung aeration. At 2 months post-discharge, residual left lower lobe volume loss and scarring remained.<br /><br />The case emphasizes that empyema is pus in the pleural space and that while common pathogens include Streptococcus pneumoniae, Staphylococcus aureus, and viridans streptococci, anaerobes such as Fusobacterium nucleatum should also be considered, especially in persistent or treatment-refractory pneumonia. Prompt recognition, anaerobic antibiotic coverage, drainage, and multidisciplinary management are key to good outcomes.

Asset Subtitle

Stephan Constante

Meta Tag

Author List Ann Marie Kumfer, Jessica Saganowich, Stephan Constante

Category Clinical Vignettes

Concept Empyema

Concept Fusobacterium nucleatum

Concept Pleural Fluid Analysis

Concept Pleural Fluid Culture

Concept Pleural Drainage

Distinguished Non-Finalist

Presenter Organization University of North Carolina

Presenting Author Stephan Constante

Track Adult

Keywords

empyema

pleural effusion

Fusobacterium nucleatum

Streptococcus anginosus

pneumonia

chest tube drainage

intrapleural dornase alfa

anaerobic infection

amoxicillin-clavulanate

loculated effusion

Empyema

Fusobacterium nucleatum

Pleural Fluid Analysis

Pleural Fluid Culture

Pleural Drainage