Abstract Introduction Parvimonas micra (P. micra) is a gram-positive anaerobic coccus that creates abscesses and empyemas and is detected on skin, oral mucosa and in the GI tract. Major risk factors include malignancy, immunocompromised state, surgery, smoking, and periodontitis. Primary infection with P. micra has rarely been documented. We present a unique case of severe pneumonia with primary infection of P. micra in a patient who was immunocompetent, with two risk factors: dental surgery, and smoking. Case Summary 56-year-old female with history of hypertension, gastroesophageal reflux disease, and asthma presented to the emergency department with complaint of two weeks of shortness of breath, fevers, and severe right-sided chest pain. Social history was significant for 22 pack/year smoking history, trip to New Mexico for a month, and recent dental procedure. Labs were significant for WBC 26.8, with 82% neutrophil predominance, elevated CRP and ESR, negative blood cultures, Aspergillus Galactomannan EIA, HIV, and Histoplasma urine antigen. CT chest showed bilateral, cavitary pulmonary nodules, mediastinal lymphadenopathy, and loculated right-sided pleural effusion. A pig tail chest tube was placed, and lytics were used for loculations. Pleural fluid studies were exudative. Culture of the anaerobic bottle showed P. micra. Patient was discharged home with four weeks of amoxicillin/clavulanic acid and follow up imaging in six weeks. Discussion P. micra, was the only isolated organism in pleural fluid suggesting a primary infection, which is rare. Furthermore, few cases of pneumonia have been reported1. Mode of infection is typically associated with arthroplasty, endocarditis, brain abscess, and discitis1. It is difficult to identify because of patient’s lack of distinct clinical symptoms and its slow growth. Diagnosis is often delayed in pneumonia, after failed treatment with usual community-acquired pneumonia coverage due to growing resistance to antibiotics such as fluoroquinolones1. Often cultures are negative and identification methods such next generation sequencing (NGS) are more definitive1. This bacterium can be multi-drug-resistant with polymicrobial presentation, creating biofilms. Conclusion P. micra is a skin and GI tract bacteria that rarely leads to primary lung and pleural cavity infection. In patients with pneumonia and associated empyema who undergo bronchoscopy, NGS of BAL fluid may be beneficial to avoid delay in diagnosis. References: 1. SHIMIZU K, HORINISHI Y, SANO C, OHTA R. INFECTION ROUTE OF PARVIMONAS MICRA: A CASE REPORT AND SYSTEMATIC REVIEW. HEALTHCARE (BASEL). 2022 SEP 8;10(9):1727. DOI: 10.3390/HEALTHCARE10091727. PMID:36141340; PMCID: PMC9498800. This abstract is funded by: NA
Lutchi et al. (Fri,) studied this question.