Case Presentation:
A 63 year‐old Caucasian male presented to the emergency department with progressively worsening, sharp, non‐radiating, right‐sided pleuritic chest pain and right upper quadrant pain. Associated with flu‐like symptoms. Past medical history was significant for well‐controlled diabetes mellitus, hypertension, colon polyps and hyperlipidemia. No recent history of travel, but possible sick contact at work. The patient works as a realtor. On admission, vital signs showed normal body temperature, tachycardia, tachypnea, hypotension, and good oxygen saturation on room air. Physical examination was remarkable for crackles at the right lung base. Laboratory data revealed leukocytosis of 11,400/mm3 with bandemia 43%, creatinine of 1.9 mg/dl, mild transaminitis, and procalcitonin of 150.16 ng/ml. Chest radiograph demonstrated right lower lobe infiltrate. Right upper quadrant ultrasound was unremarkable. The patient was started on intravenous ceftriaxone and azithromycin for community acquired pneumonia. Pneumonia and hepatitis panels were negative. On day four of hospitalization, blood cultures grew gram‐positive bacilli, which was subsequently identified as E. lenta. Antibiotics were switched to piperacillin‐tazobactam. Computed tomography of the chest, abdomen and pelvis revealed pneumonitis and an 18 mm low‐density lesion in the right lobe of liver, highly suspicious for hepatic abscess. The patient underwent ultrasound‐guided percutaneous drainage of the abscess, which grew Escherichia coli and bacteroides. He was treated with intravenous piperacillin‐tazobactam for 2 weeks, followed by oral ciprofloxacin and metronidazole for 4 weeks. The patient remained asymptomatic at follow‐up at 3 months.
Discussion:
Eggerthella lenta (E. lenta, formerly known as Eubacterium lentum), an anaerobic, non‐motile, non‐sporulating Gram‐positive bacillus, is commonly found as part of the normal human intestinal tract flora. Though it is a common commensal, it may also cause severe, disseminated infections. E. lenta has been indentified as a culprit of the genital and gastrointestinal tract pathologies, including abscesses, malignancies, decubitus ulcers, and systemic bacteremia. The reported mortality rate approximates 20‐40%. Because of the fastidious nature of the organism, the isolation of this anaerobe is difficult. The 16S rRNA gene analysis testing has been applied in the isolation of E. lenta. Co‐infection with other anaerobes is not uncommon. Eggerthella spp. is generally sensitive to penicillin and metronidazole, while sensitivity to vancomycin may vary. No large prospective studies have been done to suggest effective treatment regime.
Conclusions:
Eggerthella infections should not be considered a mere contaminant, and should be treated aggressively.