(543) Clostridium sordellii and Aspergillus fumigatus in an Immunocompetent Causing Necrotizing Pneumonia

Introduction: Acute invasive pulmonary infection due to Aspergillus species and Clostridium Sordellii is well recognized in patients who are immunocompromised. Infection in these patients can progress rapidly, and in most cases result in death. We describe a unique case of necrotizing pneumonia in a 56-year-old immunocompetent male due to co-infection with Clostridium Sordellii and Aspergillus fumigatus.

Description: A 56-year-old male patient presented to the ED for evaluation of SOB and hemoptysis that began three days ago. Medical history was significant for HTN and HLD. Patient presented with respiratory distress and hypoxia, initially requiring oxygen via bilevel ventilation. He was eventually intubated and ventilated due to worsening hypoxia. His serum study showed leukocytosis of 22.6, Cr 5.72, lactic acid of 2.1 and transaminitis suggesting severe sepsis. CT of the chest showed severe right lung necrotizing pneumonia complicated by loculated pleural effusion. He was started on broad-spectrum antibiotics. A thoracostomy was performed, draining 400 ml of hemorrhagic fluid. He then underwent video-assisted thoracic surgery (VATS) with right thoracotomy for decortication and debridement of lung. Necrotic tissue and fluid cultures returned positive for Clostridium Sordellii. Lower respiratory cultures were positive for Aspergillus fumigatus, and the patient was started on Voriconazole. Patient was on mechanical ventilation for 20 days and failed several attempts to wean off the ventilator. For this reason, a tracheostomy was performed.

Discussion: C. sordelli, a spore forming bacteria found in soil and animal intestines, is a known culprit in acute necrotizing pneumonia. Coinfection with Aspergillus fumigatus is rare and likely underreported. Risk factors for such infections include critical illnesses, cancer, burns, neutropenia, and HIV infection. C. sordelli pneumonia may present with symptoms ranging from mild pleuro-pulmonary infection to severe necrotizing pneumonia. While fatal infections may occur in more virulent strains of C. sordelli, most strains remain susceptible to penicillins. A timely diagnosis via sputum and tissue cultures along with incorporation of adequate antibacterial agents is important, as damage to the lung may be rapidly progressive.