Abstract Introduction Saccharomyces cerevisiae (brewer’s yeast) is a rarely reported cause of fungal infection, particularly in the pleural space. Invasive S. cerevisiae infections are typically only observed in immunocompromised or critically ill patients. Pleural empyema involving S. cerevisiae is exceedingly rare and has only been reported in polymicrobial settings, usually the result of gastrointestinal perforation or translocation. We present the first known case of monomicrobial S. cerevisiae empyema. Case Description A 60-year-old male with a medical history notable for esophageal stricture and alcohol use disorder presented with chest pain, odynophagia, and melena. Upper endoscopy demonstrated esophagitis without evidence of active hemorrhage. Immediately post-EGD, the patient suffered an 8-minute pulseless electrical activity arrest with return of spontaneous circulation achieved. He was then transferred to the ICU. During his ICU course, the patient developed non-convulsive status epilepticus, severe global encephalopathy, disseminated intravascular coagulation requiring transfusion of blood products, and acute tubular necrosis necessitating continuous renal replacement therapy. CT imaging of the chest revealed bilateral pleural effusions, right greater than left, with a small right-sided apical pneumothorax. A right-sided chest tube was placed for drainage, and pleural fluid cultures grew monomicrobial S. cerevisiae. Infectious Disease was consulted, and the patient was started on intravenous amphotericin B for fungal empyema. The S. cerevisiae isolate demonstrated susceptibility to amphotericin B (MIC = 0.25 μg/mL). Despite aggressive supportive care and appropriate antifungal therapy, the patient exhibited no neurological recovery and became increasingly hemodynamically unstable, ultimately exceeding maximal vasopressor support. Following multidisciplinary discussion and in accordance with goals of care, the patient was terminally extubated. Discussion To our knowledge, this is the first reported case of monomicrobial S. cerevisiae pleural empyema. The infection is most consistent with esophageal translocation, likely secondary to an EGD-induced microperforation or mucosal disruption during ACLS resuscitation. Even with prompt antifungal therapy, outcomes remain poor given the virulence of fungal empyema and the often critical condition of affected patients. Dismissal of S. cerevisiae as a contaminant should be avoided in this context. This case demonstrates that, while S. cerevisiae is rarely considered pathogenic, it is capable of causing clinically significant monomicrobial infections, expanding the pathogenic potential of this common culinary yeast. This abstract is funded by: None
Kerns et al. (Fri,) studied this question.