B73-10 A Rare Case of Fusobacterium Empyema in a Previously Healthy Male

Abstract Introduction Empyema is a serious complication of pulmonary infection and remains associated with significant morbidity and mortality. Recent microbiologic studies have highlighted the increasing recognition of Fusobacterium nucleatum as a causative organism, often linked to aspiration. This infection has been described in association with immunosuppression, but cases occurring in previously healthy individuals are rare. Case Presentation A 73-year-old male with a 45-pack-year smoking history who presented with progressive generalized weakness. He denied shortness of breath, fever, chills, or night sweats but reported an unintentional 60-pound weight loss over the past year. On arrival, he was hemodynamically stable. CT chest demonstrated a large, loculated left pleural effusion with pleural thickening suggestive of empyema and a small pneumothorax. He was empirically started on intravenous piperacillin-tazobactam. Thoracentesis with tube thoracostomy drained approximately 1 L of purulent fluid. Pleural fluid cultures grew Fusobacterium nucleatum. Swallow evaluation and barium esophagram showed oropharyngeal dysphagia with aspiration and esophageal dysmotility. The initial chest tube was removed after six days, but a recurrent pneumothorax required repeat thoracostomy, which was later removed following radiographic resolution. His hospital stay lasted approximately three weeks, during which he received nutritional support and physical therapy for severe deconditioning. He completed a six-week course of intravenous piperacillin-tazobactam and was discharged in stable condition on room air. Discussion Fusobacterium nucleatum is an anaerobic gram-negative bacterium often found in oral flora and originally isolated in dental plaque. Although it has been associated with periodontal disease in the past, fusobacterium nucleatum has also been isolated in the blood, obstetric infections, genitourinary system, brain, and liver. While fusobacterium has been a cause of respiratory infections it is often associated with malignancy, immunosuppression, and poor dentition. Our case highlights a case of severe empyema in an immunocompetent patient without any of these risk factors. It was only through additional investigation that we found our patient to have dysphagia and aspiration. This presents a plausible source for Fusobacterium nucleatum. Recognizing Fusobacterium nucleatum as a potential pathogen is necessary given its indolent onset and potential for severe loculated empyema requiring aggressive management. Our case underscores that F. nucleatum empyema should be considered even in patients without immunosuppression or significant comorbidities, particularly when imaging reveals loculated pleural effusion and aspiration risk factors are present. Increased awareness of this organism’s pathogenic potential can facilitate earlier recognition and appropriate treatment, potentially reducing morbidity associated with delayed diagnosis. This abstract is funded by: None