CRA34 WHEN PARADISE BECOME PATHOGENIC: A RARE CASE OF PARVIMONAS MICRA LUNG EMPYEMA IN A TEENAGE SWIMMER

Shean Hong Ng, Ummi Nadira Binti Daut, Tasnim Abdul Aziz

Medical Department Medicine Faculty, University Putra Malaysia, Serdang Malaysia.

Introduction
Parvimonas micra is an uncommon but emerging anaerobic pathogen in pleuropulmonary infections. Freshwater exposure is not previously a well-established risk, but possible through aspiration or colonization of oropharynx during swimming in unclean water.Management of Parvimonas micra empyema involves early initiation of antibiotics with anaerobic coverage (e.g., penicillin, metronidazole), effective pleural drainage (starting with pigtail catheter and escalating to chest tube or surgery if loculated), and supportive care.

Case report
We report the case of a 14-year-old male who presented with right-sided empyema following recreational freshwater exposure, developing pyrexia and unilateral pleuritic chest pain approximately one week after pond swimming. Laboratory investigations revealed elevated inflammatory markers consistent with sepsis, while computed tomography of the thorax demonstrated bilateral lower lobe patchy consolidative changes secondary to an infectious process, with segmental atelectasis of the right lower lobe and a large right-sided loculated pleural effusion. Pleural fluid culture yielded Parvimonas micra, confirming the etiological agent responsible for the empyema. Initial management included percutaneous drainage via pigtail catheter insertion followed by surgical decortication; however, the patient exhibited poor clinical response to conservative management over a prolonged period. The persistence of the loculated pleural collection and inadequate drainage necessitated further surgical intervention with formal chest tube thoracostomy to achieve effective pleural space drainage, demonstrating the refractory nature of this empyema and the need for escalated drainage procedures due to the complex loculated morphology and resistance to initial therapeutic measures.

Discussion
This case is particularly interesting due to the rare isolation of Parvimonas micra in a previously healthy adolescent following freshwater exposure, highlighting an uncommon but clinically significant cause of empyema with a refractory course requiring advanced surgical management.