TP097 UNCOMMON CASE REPORTS OF RESPIRATORY INFECTIONS / Thematic Poster Session

Corynebacterium Striatum Empyema in an Immunocompetent Patient with

COPD

K. C. Guice1, A. P. Holt2; 1Internal Medicine, University of Tennessee Health Science Center, Memphis, TN, United
States, 2Pulmonary and Critical Care Medicine, University of Tennessee Health Science Center, Memphis, TN,
United States.

Corresponding author's email: kguice2@uthsc.edu

Introduction: Corynebacteria are normal commensal skin flora that rarely cause invasive disease. Here we
present a case of Corynebacterium striatum empyema masquerading as a non-resolving pneumonia. Case
Summary: 82-year-old female with a history of chronic obstructive pulmonary disease (COPD), nonalcoholic
steatohepatitis (NASH) cirrhosis, and chronic right pleural effusion presented with worsening dyspnea and
cough. She had previously been treated three times for right lower lobe pneumonia with broad-spectrum
intravenous antibiotics. Chest CT on admission showed a moderate-sized, loculated pleural effusion. Diagnostic
thoracentesis yielded cloudy fluid with WBC count of 214,000 with 85% neutrophils. Pleural fluid LDH was 155
mg/dL and protein 1.5 mg/dL. The patient improved with IV antibiotics and was discharged to complete a 10-day
course of levofloxacin. After 9 days of incubation, pleural fluid cultures grew Corynebacterium striatum. The
patient was readmitted for persistent right-sided chest pain. The patient was started on broad-spectrum
antibiotics, including vancomycin. Thoracic Surgery performed a VATS and decortication for chronic empyema.
Unfortunately, the patient developed postoperative hemorrhage, shock, and eventually died. Pleural peel and
pleural fluid cultures grew Corynebacterium striatum. Discussion: Corynebacteria are commensal gram-positive
bacilli that are normal flora and often dismissed as contaminants. The most well-known corynebacterium, C.
diphtheria causes the disease diphtheria and thus other species have been previously labeled “diphtheroids”.
Corynebacteria infrequently causes invasive disease but is now emerging as a multi-drug resistant pathogen.
Typical sources include open wounds, surgical sites, bloodstream, and sputum.1 Pneumonia and empyema
secondary to Corynebacteria has been mostly reported in immunocompromised individuals. However, C.
striatum has been isolated in immunocompetent patients with previous antibiotic exposure leading to its
emergence as a multidrug-resistant organism.2 C. striatum pulmonary infectious are commonly implicated with
impaired mucociliary clearance and bypassed upper airways such as tracheostomy or laryngectomy. To the best
of our knowledge, there are only two reported cases of C. striatum empyema. One patient had severe
rheumatoid arthritis on immunosuppressants and the other had an intracerebral hemorrhage.2,3 Due to its
frequent misidentification as coagulase-negative staphylococcus, a multifaceted approach to isolation is
imperative including gram staining and MALDI-TOF mass spectrometry.4 A retrospective review found 71% of
clinically relevant C. striatum infections to be resistant to nearly all oral antibiotics except linezolid. The workhorse
empiric antibiotic for C. striatum infections is vancomycin.5 Conclusion: Corynebacterium striatum is an emerging
respiratory pathogen. Pleural space infections due to Corynebacterium species are rare and more commonly
present in immunocompromised patients.

This abstract is funded by: None

Am J Respir Crit Care Med 2021;203:A3967

Internet address: www.atsjournals.org Online Abstracts Issue