Clostridium Perfringens Pleural Effusion as First Presentation for Malignant Mesothelioma

Document Type

Conference Proceeding

Publication Date

5-21-2023

Publication Title

Am J Respir Crit Care Med

Abstract

Introduction Clostridium perfringens, a gram-positive anaerobic bacillus, is an unusual cause of pulmonary infections. Rare cases previously described were associated with invasive procedures or trauma (1)(2). Here, we describe a case of Clostridium perfringens infection in a pleural effusion. Case Presentation An 84-year-old female with history of triple negative, stage IIA, poorly differentiated invasive ductal carcinoma of the left breast, treated 5 years prior with lumpectomy, chemotherapy, and radiation. Patient presented with lightheadedness and fatigue. Neurologic exam was normal. Chest x-ray showed left pleural effusion with new mass-like opacity adjacent to the aortic arch. Computed tomography of the chest demonstrated speculated apical left upper lobe nodule, a conglomerate mass in the sub-carinal region with pleural thickening, and pleural masses near the left costophrenic angle. Thoracocentesis was done along with biopsy of the pleural mass. Cultures grew Clostridium perfringens and pleural nodule biopsy was positive for malignant mesothelioma. Patient remained afebrile with minimal dyspnea. She was treated with Ampicillin- Sulbactam for a total course of 4 weeks. Discussion: Few cases of spontaneous Clostridium perfringens pleuropulmonary infection have been reported in literature. Previously described cases were associated with either aspiration, penetrating chest wall injuries, invasive procedures, or a gastrointestinal source (1-5). Others were related to hematogenous seeding of infarcted lung tissue (6). Spontaneous bacterial empyema was documented in cirrhotic patients (7). Most cases were associated with necrotizing pneumonia, empyema, or sepsis; requiring extensive antibiotic regimens and source control (1,3,4). Our patient presented only with nonspecific symptoms of lightheadedness, fatigue, and minimal respiratory symptoms. While there is no known source of this spontaneous infection, the concomitant finding of a pleural mass, which later resulted as mesothelioma, escalated the complexity of this infection. Other than the previously undiagnosed mesothelioma, our patient did not have the usual risk factors for Clostridium perfringens infection. Patient remained clinically stable with adequate response to antibiotics, and had negative pleural fluid cultures following treatment. Regarding her mesothelioma, PET scan demonstrated extensive metastatic disease. She elected not to undergo any treatment and ultimately decided to enroll into hospice. In conclusion, Clostridium perfringens infections involving the pleural fluid usually presents after invasive procedures or other risk factors. Our case represents spontaneous clostridium empyema in a patient with previously undiagnosed mesothelioma. Although respiratory symptoms were minimal, the mainstay of treatment includes drainage and antibiotics. This is the first case to our knowledge of mesothelioma presenting with Clostridium perfringens pleural effusion.

Volume

207

Issue

1

First Page

A2106

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