Massive empyema due to Lactococcus garvieae

Abstract

Introduction: Lactococcus garvieae, a zoonotic pathogen, may rarely infect humans through the consumption of fish. Documented manifestations of L. garvieae infection in humans include infective endocarditis, prosthetic joint infections, liver abscesses, peritoneal dialysis-associated peritonitis, osteomyelitis, meningitis, infective spondylodiscitis, acalculous cholecystitis, and urinary tract infection.

Case report: An 87-year-old female was hospitalized for coffee-ground emesis secondary to acute gastritis after eating cooked fish. One week after her discharge, she developed new-onset confusion and was returned to the hospital. Chest computed tomography revealed total consolidation of the left lung and a multiloculated left pleural effusion. The patient required intubation and direct admission to the intensive care unit. Pleural fluid and blood cultures grew L. garvieae, which was susceptible to ceftriaxone, penicillin, and vancomycin. Despite intensive antibiotic therapy and supportive care for thirteen days, the patient remained in irreversible shock, and the family opted for comfort care.

Conclusions: Heretofore unreported, this case demonstrates that L. garvieae can cause bronchopneumonia and empyema.

Keywords: Lactococcus garvieae; critical care; empyema; septic shock.

Figure 1

Timeline detailing the patient’s hospital course and antibiotic therapy BAL – bronchoalveolar lavage. Antibiotic dosing is represented as total mg daily.

Figure 2

(A) Chest X-ray showing complete opacification of the left hemithorax. (B) Lung window of chest CT without contrast demonstrating right and left mainstem bronchi with endobronchial debris, scattered right-sided ground glass opacities (red arrowheads) and complete left lung atelectasis. (C) Abdominal window of chest CT without contrast revealing multiloculated pleural effusion surrounding the left lung (white arrowheads).