Fusobacterium nucleatum-Induced Empyema Masquerading as Lung Cancer: A Diagnostic Challenge

Our plain-English summary of Fusobacterium nucleatum-Induced Empyema Masquerading as Lung Cancer: A Diagnostic Challenge, by A.R. Fadel, Y.N. Ahmed (Curēus, 2024).

The study

• Authors: A.R. Fadel, Y.N. Ahmed
• Journal: Curēus
• Published: 2024;16(12):e75003
• Type of article: Case report
• Read it: PubMed · Publisher · Free full text

Abstract

A 73-year-old man, an ex-smoker with a history of asbestos exposure and hypertension, presented with progressive shortness of breath, weight loss, loss of appetite, and fatigue. He was referred by a general practitioner for evaluation of a round lesion in the right lung. Chest computed tomography (CT) revealed a pleural-based mass and small right-sided pleural effusion that was not amenable to aspiration. Routine blood investigations revealed elevated levels of the inflammatory markers. He was discharged with a course of oral antibiotics, levofloxacin, and scheduled for a two-week follow-up on the lung cancer pathway. The patient returned with worsening shortness of breath and enlarged pleural effusion. Ultrasound-guided diagnostic aspiration yielded purulent fluid, with cultures identifying Fusobacterium nucleatum. Cytological examination of the pleural fluid yielded negative results for malignant cells. Further investigations ruled out septic thrombophlebitis of the internal jugular vein (Lemierre syndrome) and septic mediastinitis. After excluding all other possible infection sites and conducting an oral examination, the pleural infection was attributed to periodontal disease. Empyema was effectively managed with antibiotics and drainage. However, empyema resulted in a visceral pleural rind, leading to an unexpandable lung. Surgical intervention was not pursued because of the patient's comorbidities and clinical and biochemical resolution of the infection. This case highlights the importance of considering rare pathogens, such as Fusobacterium nucleatum, in pleural infections, particularly when linked to oral sources.

Copyright © 2024, Fadel et al.

In plain English

This was a case report about one 73-year-old man treated at Dartford and Gravesham NHS Trust in the United Kingdom. The article's abstract describes him as an ex-smoker with a history of asbestos exposure. It gives no details of that exposure, and asbestos is not discussed anywhere else in the article. He also had high blood pressure, extensive gum (periodontal) disease, and a fall onto the right side of his chest three months earlier. A chest X-ray showed a 34 mm lesion in the right lung, and a CT scan showed a mass against the lung lining (pleura), which raised concern about cancer. When he returned with worse symptoms, a chest drain removed more than 1 liter of pus from around the lung. Cultures grew the mouth bacteria Fusobacterium nucleatum and Leptotrichia species. Pleural fluid tested later showed no cancer cells. The authors attributed the infection (empyema) to his gum disease. Antibiotics and drainage controlled it without surgery, but thick scarring left the lung unable to fully re-expand. The authors concluded that such mouth-source pleural infections can be hard to diagnose and can resemble cancer.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: case report
• Who was studied: One 73-year-old man with hypertension, extensive periodontal disease and a recent fall on the right side of his chest, referred by his general practitioner to a hospital of Dartford and Gravesham NHS Trust, UK
• Exposure: The article's abstract states a history of asbestos exposure, together with being an ex-smoker. No fiber type, job, duration or dose is given, and the exposure is not discussed in the case description or discussion. The illness studied was a pleural infection caused by Fusobacterium nucleatum.
• Main results:
  • The initial chest X-ray showed a 34 mm lesion in the right lung.
  • CT showed a pleural-based, low-density mass of 38 × 36 mm at the edge of the middle lobe, investigated as possible malignancy.
  • C-reactive protein was 97 mg/L on first admission and rose to 184 mg/L on return (reference range below 5 mg/L).
  • A chest drain removed more than 1 liter of pus.
  • Pleural fluid cultures grew Fusobacterium nucleatum and Leptotrichia species.
  • At outpatient review, cytology of the re-accumulated pleural fluid was negative for malignant cells.
  • Periodontal disease was judged the primary source of the infection.
  • The surgical team judged surgery unnecessary. Re-accumulated fluid was attributed to a non-expandable lung caused by a visceral pleural rind, not to recurrent empyema.
• The authors' conclusion: The authors concluded that the case highlights the diagnostic and therapeutic complexities of oral-type pleural infections involving rare pathogens. They noted that the findings initially raised concern for malignancy, and that antibiotics and chest drainage were effective without surgery.

Topics

Medical terms in this study, explained in our Lexicon: Empyema, Lung Cancer, Asbestos Exposure, Pleural Effusion, Ultrasound, Trapped Lung.

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