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￭ S-655 ￭
A rare case of spondylodiscitis with epidural abscess caused by Cardiobacterium valvarum
1Division of Infectious Disease, Department of Internal Medicine, 2Department of Laboratory Medicine, 3Department of Neurosurgery, Korea University Ansan Hospital, Ansan, Korea
*Kyungmi Lee1, Wonsuk Choi1, Daewon Park1, Chihyun Cho2, Sehoon Kim3
Cardiobacterium valvarum is Gram-negative bacteria of the HACEK group (Haemophilus parainfluenzae, Aggregatibacter spp., Cardiobacterium spp., Eikenella corrodens, and Kingella spp.). C. valvarum was first described in patient with endocarditis complicated by ruptured mycotic aneurysm in 2004. Since then, all the reported cases caused by C. valvarum were endocarditis-related ones. We report here the isolation of a C. valvarum from a pa- tient who suffered from spondylodiscitis with epidural abscess. A 83-year-old man presented to the emergency department with complaints of low back pain and numbness of both legs that started 2 months ago. Neurological exam showed L5 dermatome numbness with pain and magnetic resonance imaging study of the spine showed spondylodiscitis at L5-S1-2. Empirical therapy with Ceftriaxone was initiated, but later we put him on meropenem due to constant fever along with no improvement on pain. In blood culture, C. valvarum was identified. After which, two more blood cultures that were done also show C.valvarum. An echocardiogram was done and found no infective endocarditis in this case unlike the previously reported C. valvarum infection. Followed-up MRI of spine done after two months of antibiotic treatment still showed epidural abscess, which made us put him on Cefepime for another month. Both his symptoms and MRI of spine showed improvement, which led him to be discharged from our institution. We report the first case of spondylodiscitis caused by Cardiobacterium valvarum, a well-known endocarditis-causing rare species.
￭ S-656 ￭
Empyema necessitatis caused by Streptococcus agalactiae: a case report and revie w of literatures
1Department of Internal Medicine, Kyung Hee University School of Medicine, 2Department of Endocrinology and Metabolism, Kyung Hee University School of Medicine, 3Department of Infectious Disease, Kyung Hee University School of Medicine
Dong Youn Kim1*, Sang Youl Rhee2, Ki Ho Park3, Yu Jin Kim2, Suk Chon2, Seungjoon Oh2, Jeong-Taek Woo2, Sung Woon Kim2.
Empyema necessitatis is a rare complication of empyema that is defined by the extension of an empyema from pleural cavities to the surrounding structures. It is usually occurred after thoracic surgery, or caused by tuberculosis (TB) or actinomycosis. Streptococcus agalactiae hasn’t been reported as the causative agent of empyema necessitatis. We report the case of empyema necessitatis caused by Streptococcus agalactiae. A 72-year-old female presented to hospital with complaints of right shoulder pain and swelling of right upper chest of 2 weeks duration. While the patient had a history of diabetes and peripheral arterial occlusive disease, she had not history of tuberculosis and thoracic surgery. Computed tomography (CT) confirmed a consolidation on peripheral portion of right upper lobe apex with extension through anterior chest wall with abscess formation. Percutaneous tube thor- acostomy of right upper chest wall mass was performed. Culture of the abscess was positive for Streptococcus agalactiae, which was highly pen- icillin-susceptible. After the drainage and the administration of penicillin, chest wall mass was reduced in size and upper chest wall pain improved.
After 4weeks, chest CT revealed marked improvement of abscess. We searched articles about empyema necessitatis caused by bacteria in the English literature up to 2015, using Pubmed and Medline. After excluding TB, actinomycosis, fungus causes, and non-infectious causes, we identified 18 cases of empyema necessitatis. 13 (72%) patients were male, and the median age was 28 years (range, 4 week-72 years). The most frequently isolated organ- isms were Staphylococcus aureus (61% [11/18]), with 63% (7/11) being methicillin-resistant. Although TB and actinomycosis have been reported to be most common causes of empyema necessitatis, but here we found that pyogenic bacteria were not uncommon etiology of these infections. Therefore, when the clinicians encounter the patients with suspected empyema necessitatis, pyogenic bacteria as well as TB and actinomycosis should be consid- ered in differential diagnosis. Empyema necessitatis caused by drug-resistant organisms such as methicillin-resistant S. aureus challenge the clinicians who treated these diseases.
