Clostridioides difficile recovered in pleural fluid: Contamination or infection? A case report of a proven empyema and a literature review

Abstract

Introduction: Pleural empyema is an infrequent manifestation of extraintestinal Clostridioidesdifficile infection, with just eight cases reported in literature.

Methods: We report a new case in a 70-year-old male without comorbidities or evidence of concomitant gastrointestinal disease, and review the previous cases reported in the literature.

Results: The isolate was susceptible to all antimicrobial tested and was negative for A+B toxins. The patient fully recovered after drainages and antimicrobial therapy with amoxicillin-clavulanate and doxycycline.

Conclusion: As in the previously reported cases, aspiration was the most plausible hypothesis of mechanism of infection in our patient. Empyema by Clostridioidesdifficile is a diagnostic challenge, since it is necessary to rule out that the isolation of this microorganism in pleural fluid is not a contamination. Furthermore, more evidence is needed for its treatment since data regarding this entity are still scarce.

Keywords: Amoxicilina-clavulánico; Amoxicillin–clavulanate; Aspiration; Broncoaspiración; Clostridioides difficile; Clostridioidesdifficile; Doxiciclina; Doxycycline; Empiema; Empyema.