A case of pulmonary Serratia marcescens granuloma radiologically mimicking metastatic malignancy and tuberculosis infection.
Serratia marcescens is a saprophytic gram-negative bacillus capable of causing a wide range of infections. A 57-year-old female was admitted to our hospital for four weeks with community acquired pneumonia. A chest x-ray, six weeks after discharge, demonstrated multiple, bilateral 'cannon ball'-like opacities and mediastinal lymphadenopathy which were highly suspicious of disseminated malignancy or tuberculosis. The only symptom that this patient had was a productive cough. She had multiple commodities, but no specific immunodeficiency disorder. Interestingly, her sputum and bronchial washing samples grew S. marcescens. The computed tomography-guided lung biopsy demonstrated necrotic granulomatous changes. There was no pathological evidence of tuberculosis or fungal infection, malignancy or vasculitis. There are only a handful of reported cases of Serratia granulomas. Thus, we are reporting a rare instance of pulmonary Serratia marcescens granuloma radiologically mimicking metastatic malignancy and tuberculosis infection.
Core Medical Trainee, North Western Deanery, UK j.das@doctors.org.uk.
Joyutpal
J
Das
Foundation Year 2 Doctor, North Western Deanery, UK.
Benjamin
B
Layton
Foundation Year 1 Doctor, North Western Deanery, UK.
Harriet
H
Lamb
Consultant Respiratory Physician, Trafford General Hospital, UK.
Nicola
N
Sinnott
Consultant Respiratory Physician, Trafford General Hospital, UK.
Bernard C
BC
Leahy
D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D003937:Diagnosis, Differential; D005260:Female; D006760:Hospitalization; D006801:Humans; D009894:Opportunistic Infections / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000382:microbiology*; D010397:Penicillanic Acid / Q000008:administration & dosage / Q000031:analogs & derivatives*; D010878:Piperacillin / Q000008:administration & dosage; D000077725:Piperacillin, Tazobactam Drug Combination; D011014:Pneumonia / Q000150:complications / Q000276:immunology / Q000382:microbiology*; D013902:Radiography, Thoracic; D016868:Serratia Infections / Q000000981:diagnostic imaging* / Q000276:immunology / Q000382:microbiology; D012706:Serratia marcescens / Q000187:drug effects / Q000302:isolation & purification; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014376:Tuberculosis / Q000175:diagnosis
D000900:Anti-Bacterial Agents; D000077725:Piperacillin, Tazobactam Drug Combination; D010397:Penicillanic Acid; D010878:Piperacillin
Serratia marcescens; granuloma