Postoperative Empyema Due to Leclercia adecarboxylata Following Mesothelioma Surgery: A Case Report

Our plain-English summary of Postoperative Empyema Due to Leclercia adecarboxylata Following Mesothelioma Surgery: A Case Report, by J.F. Montenegro, M.Á. Diaz-Diaz, S. Vidal-Cañas, et al (Pathogens, 2025).

The study

• Authors: J.F. Montenegro, M.Á. Diaz-Diaz, S. Vidal-Cañas, G. Urriago, V. Correa, L.Á. Melo-Burbano, Y. Liscano
• Journal: Pathogens
• Published: 2025;14(2)
• Type of article: Case report
• Cited by: 2 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Background/objectives: Leclercia adecarboxylata (L. adecarboxylata) is a rare opportunistic pathogen that can cause severe infections like empyema, particularly in immunocompromised individuals. We aim to highlight the importance of the early detection and personalized treatment of L. adecarboxylata infections in patients with comorbidities such as malignant mesothelioma.

Methods: We present the case of a 57-year-old man with type 2 diabetes mellitus, hypertension, and malignant mesothelioma who developed a parapneumonic effusion that progressed to empyema. After undergoing pleurectomy and pleurodesis, intraoperative cultures identified L. adecarboxylata. Targeted antibiotic therapy was initiated based on the culture results, and the patient's response was closely monitored.

Results: The patient responded well to targeted antibiotic therapy with ampicillin/sulbactam following the initial empirical treatment with piperacillin/tazobactam. The identification of L. adecarboxylata-a rare finding in empyema cases-was crucial for effective management. The patient recovered fully without complications, highlighting the importance of the early identification and individualized treatment of infections caused by rare pathogens.

Conclusions: This case underscores the need to consider L. adecarboxylata in immunocompromised patients presenting with unusual infections. Early detection through advanced diagnostic techniques and personalized antibiotic therapy can improve clinical outcomes and help prevent antimicrobial resistance. Increased clinical awareness and further research into the resistance patterns and treatment approaches for L. adecarboxylata are essential to enhance patient care.

In plain English

This case report described one patient, a 57-year-old man with type 2 diabetes and high blood pressure, treated at the authors' institution in Colombia. He was first given a 30-day course of the steroid dexamethasone for suspected neck nerve pain. Scans then showed fluid around the left lung and a mass at the top of that lung, and he had lung surgery (pulmonary decortication). He was readmitted 8 days later with pulmonary sepsis. A CT scan showed a walled-off collection of pus (empyema) in the left chest. Cultures taken during a second operation (pleurectomy and pleurodesis) grew Leclercia adecarboxylata, a rare bacterium. Blood and urine cultures were negative. He received intravenous ampicillin/sulbactam for 6 weeks without susceptibility testing, and his symptoms gradually resolved. Tissue tests found cancer cells in the pleura consistent with malignant mesothelioma, which was then treated with chemotherapy. The authors concluded that this bacterium should be considered in immunosuppressed patients with unusual infections. They noted that no genetic testing was done. The article does not mention asbestos exposure.

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 of a single patient
• Who was studied: One 57-year-old man with type 2 diabetes mellitus and hypertension, treated at the authors' institution in Colombia (ethics approval from the Clínica de Occidente, Cali). The dates of care are not given.
• Exposure: The article does not report any asbestos or occupational exposure. The exposures it describes are a 30-day course of dexamethasone, which the authors link to the patient's immunosuppression, and infection with the bacterium Leclercia adecarboxylata after chest surgery.
• Main results:
  • The patient was readmitted 8 days after pulmonary decortication and pleurodesis, with pulmonary sepsis and systemic inflammatory response syndrome. Among other abnormal blood results, his C-reactive protein was 269.7 mg/L (reference less than 10 mg/L).
  • A chest CT showed a loculated empyema in the left hemithorax, with near-total collapse of the lower lobe and partial collapse of the upper lobe, and a suspected bronchopleural fistula.
  • Cultures taken during pleurectomy and pleurodesis grew Leclercia adecarboxylata. Blood cultures were negative after 5 days and the urine culture was negative.
  • The bacterium was identified by mass spectrometry (VITEK MS system) with 99.6% confidence.
  • No antibiotic susceptibility testing was done. Treatment was chosen from the susceptibility patterns reported in the literature.
  • After initial piperacillin/tazobactam, the patient received intravenous ampicillin/sulbactam for 6 weeks. He showed gradual resolution of symptoms and normalization of inflammatory markers while hospitalized at home.
  • Pathology and immunohistochemistry from an outside institution showed neoplastic cells in the pleura, which the article reports as consistent with malignant mesothelioma of the epiploic variety, with a Ki67 index of 8%.
  • The patient was then treated by oncology with pemetrexed, cisplatin and pembrolizumab, and the article reports good symptomatic relief.
• The authors' conclusion: The authors concluded that the case highlights the importance of early detection and management of L. adecarboxylata infections in immunosuppressed patients, who may present with atypical infections. They called for further research into resistance patterns and treatment of this bacterium.
• Limitations the authors state:
  • No genetic testing of the bacterium was done, so possible underlying resistance mechanisms could not be assessed.
  • Treatment relied on antibiotic susceptibility patterns from the literature, which may not capture variation in resistance across settings and patient populations.

Topics

Medical terms in this study, explained in our Lexicon: Empyema, Mesothelioma, Pleurodesis.

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