THE GREENS' CAUSING EMPYEMA THORACIS WITH LUNG ABSCESS IN PATIENT WITH ACHALASIA

TOPIC: Chest Infections TYPE: Medical Student/Resident Case Reports INTRODUCTION: Physicians recognize the problem of lung abscesses and empyema thoracis since time Hippocrates, it continues to pose a challenge for present-day physicians. Anaerobic bacterial infection was considered most common cause abscess until current century. However, other infectious causes are becoming increasingly as more patients present with complex co-morbidities or/severe immunosuppression. CASE PRESENTATION: An 85-year-old male past medical history atrial fibrillation, achalasia, malignant melanoma, monoclonal gammopathy uncertain significance (MGUS) presented emergency department complaints generalized malaise, non-productive cough, shortness breath two weeks. On arrival, he afebrile, heart rate 91 bpm, Blood Pressure 101/83 mmHg, respiratory 24, requiring 3-liter oxygen via nasal cannula keep saturation (SPo2) >92%. physical examination, had decreased sounds on right side. x-ray showed large pleural effusion that further characterized CT scan chest significant loculated causing near complete atelectasis distended esophagus fluid debris. He underwent ultrasound-guided thoracentesis, 800 cc serous drained. Pleural analysis consistent exudative effusion, gram stain revealed gram-positive cocci in pairs chains. He, unfortunately, suffered pneumothorax post-procedure tube placement. Due lack improvement his clinical status after thoracostomy, decision made video-assisted thoracoscopic surgery (VATS) decortication, which upper lobe cultures grew Streptococcus viridans sole pathogen, antibiotics were de-escalated. Before discharge, botulinum toxin injection lower esophageal sphincter manage achalasia later discharged rehab. DISCUSSION: Although strains streptococci, from Latin "vĭrĭdis," green, known be among etiologic agents endocarditis, their involvement diseases than endocarditis has not received much attention. In retrospective study 255 clinically confirmed or abscess, streptococci recovered pathogens substantial portion isolates.[1] CONCLUSIONS: viridans, an oral microbe, can complicated parapneumonic effusions leading complications like surgical intervention high risk aspiration this patient chronic achalasia. REFERENCE #1: Jerng JS, Hsueh PR, Teng LJ, Lee LN, Yang PC, Luh KT. Empyema caused by streptococci. Am J Respir Crit Care Med. 1997 Nov;156(5):1508-14. doi: 10.1164/ajrccm.156.5.97-03006. PMID: 9372668. DISCLOSURES: No relevant relationships Hafiz Muhammad Siddique Qurashi, source=Web Response Navitha Ramesh, Tabinda Saleem, Michaela Sangillo,