title: Propionibacterium acnes as a cause of lung abscess in a cardiac transplant recipient.
abstract: A 29-year-old man was admitted with fevers, cough, left-sided chest pain and lethargy for 1 week. He had a cardiac transplant 10 years prior and was on immunosuppressive drugs. He was found to have a pulmonary lesion and went on to develop a lung abscess. Propionibacterium acnes was identified on matrix-assisted laser desorption ionisation mass spectrometry-time of flight and 16s rRNA gene sequencing after drainage. He was curatively treated with co-trimoxazole and co-amoxiclav. He divulged a longstanding history of seborrhoeic dermatitis with frequent flares leading to large volumes of squames collecting on his bed sheets. We hypothesise this was a possible route of entry: inhalation of the Propionibacterium. This case highlights how a common commensal bacterium, P. acnes, was able to cause pathology in an immunosuppressed patient. This is the only case of a patient with transplantation developing a P. acnes pulmonary infection and the only case of P. acnes causing these clinical features to be reported in the literature.
authors.affiliation: Department of Infectious Diseases, University College London Hospital, London, UK.
authors.forename: David
authors.initials: D
authors.lastname: Veitch
authors.affiliation: Department of Infectious Diseases, University College London Hospital, London, UK.
authors.forename: Abu
authors.initials: A
authors.lastname: Abioye
authors.affiliation: Department of Infectious Diseases, University College London Hospital, London, UK.
authors.forename: Stephen
authors.initials: S
authors.lastname: Morris-Jones
authors.affiliation: Department of Infectious Diseases, University College London Hospital, London, UK.
authors.forename: Alastair
authors.initials: A
authors.lastname: McGregor
mesh_terms: D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D003937:Diagnosis, Differential; D016908:Gram-Positive Bacterial Infections / Q000175:diagnosis* / Q000188:drug therapy; D016027:Heart Transplantation; D006801:Humans; D016867:Immunocompromised Host; D008169:Lung Abscess / Q000175:diagnosis* / Q000188:drug therapy / Q000382:microbiology*; D008297:Male; D011425:Propionibacterium acnes / Q000235:genetics / Q000302:isolation & purification*; D012336:RNA, Ribosomal, 16S / Q000032:analysis; D012367:RNA, Viral / Q000032:analysis; D017423:Sequence Analysis, RNA; D015662:Trimethoprim, Sulfamethoxazole Drug Combination / Q000627:therapeutic use
chemical_list: D000900:Anti-Bacterial Agents; D012336:RNA, Ribosomal, 16S; D012367:RNA, Viral; D015662:Trimethoprim, Sulfamethoxazole Drug Combination