Endobronchial Infection and Bacterial Lymphadenitis by Gemella morbillorum Leading to Airway Perforation and a Bronchopleural Fistula.

Abstract

Introduction: Necrotizing bronchial infection with severe infectious lymphadenitis is infrequently encountered and most commonly ascribed to Aspergillus, Histoplasma, and Mycobacterium species. We present a unique cause of severe airway destruction with lymphadenitis and bronchopleural fistula formation by the bacterium Gemella morbillorum. Case: A 24-year-old man presented with acute symptoms of vomiting, fever, and shoulder pain. A CT of the chest demonstrated a large subcarinal mass encasing the central bronchi. The workup for malignant, fungal, and granulomatous etiologies was unrevealing, while blood cultures identified G. morbillorum. Fiberoptic bronchoscopy revealed a perforation of the right middle lobar bronchus and the formation of a bronchopleural fistula, resulting in a large hydropneumothorax with empyema. Despite antibiotic therapy, surgical intervention to repair the fistula, and ventilatory support, the progression of the bronchopleural fistula led to fatal respiratory failure. Conclusion: In cases of severe mediastinal adenopathy in a young patient, bacterial lymphadenitis should be considered in the differential diagnosis with lymphoma, germ cell tumor, granulomatosis with polyangiitis, sarcoidosis, histoplasmosis, and inflammatory myofibroblastic tumor.