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Pleural Empyema Caused by Rare Infection in a Patient With CLL

By: Melissa Steele-Ogus
Posted: Wednesday, July 8, 2020

Secondary pulmonary infections are not uncommon in immunocompromised patients, including those with chronic lymphocytic leukemia (CLL). Most are due to Streptococcus species and other anaerobes or less commonly Staphylococcus aureus. The Capnocytophaga species rarely has been found to cause disease, but a case report in ID Cases describes such an occurrence (pleural empyema) in a 62-year-old man with untreated CLL.

“In patients with CLL or other immunosuppressive diseases, it is crucial to consider all possible etiologies and pathogens to better direct antimicrobial therapy and prevent recurrence,” suggest Samantha A. Basco, PharmD, of Benefis Hospitals, Great Falls, Montana, and colleagues.

The male patient complained of weight loss, shortness of breath, and a worsening cough but no fever. A chest radiograph and CT scan revealed a large pleural effusion in the left lobe of his lung. Bloodwork showed a high white blood cell count, indicating infection. After peripheral blood flow cytometry and fluorescent in situ hybridization analysis, the patient was diagnosed with CLL and admitted to the hospital.

Ultrasound-guided thoracentesis and then video-assisted thoracoscopic surgery to drain fluid were employed; samples from both procedures yielded gram-negative bacilli after 72 hours of incubation. Although the species was not readily apparent, it was subsequently found to be Capnocytophaga ochracea (generally found in the oral cavity).

The patient left the hospital against medical advice and failed to fill his prescription for amoxicillin-clavulanate or to follow-up with the infectious disease clinic. He had one follow-up with oncology and received the tyrosine kinase inhibitor ibrutinib to treat his CLL. Repeat thoracentesis revealed the infection persevered, but at that time, the patient ceased to continue care with either clinic.

Disclosure: The authors reported no conflicts of interest.



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