Abstract
Introduction/Objective When the spleen is missing, the abilities of powerful immune cells are hindered, rendering individuals susceptible to infections. Patients with asplenia are at increased likelihood of infection via encapsulated organisms, including Streptococcus pneumoniae, Neisseria meningitidis, and Haemophilus influenzae. Cystic fibrosis patients are also at an increased risk of lung infections in large part due to the thick, sticky mucus in their airways that impairs mucociliary clearance and creates an environment conducive to chronic bacterial colonization and infection. P. aeruginosa, S. aureus, and B. cepacian are common culprits of infection in CF patients. Methods/Case Report A 43-year-old male with history of cystic fibrosis (CF) and splenectomy presented to the ER with a 4-day history of fevers, chills, and productive cough. Past medical also notable for admission and treatment of MRSA three weeks prior, thought to be resolved. A CXR found new hazy right middle and lower lobe consolidations consistent with pneumonia; he was admitted for fever, tachycardia, tachypnea, leukocytosis (13.9), AKI, and sepsis. Following negative COVID-19 and influenza tests, empiric Zosyn and Vancomycin treatment was started considering his recent hospital admission. A PCR respiratory pathogen panel returned positive for mycoplasma pneumonia, all other negative, altering treatment to azithromycin and ending empiric Zosyn and Vancomycin. Notably, there was no growth in blood or sputum culture. CT chest report read RLL opacities consistent with pneumonia and bronchiectasis consistent with history of CF. Bronchoscopy with bronchoalveolar lavage (BAL) revealed stain and culture negative for microbial growth and signs of malignancy. Patient discharged home on oral Bactrim, for gram positive bacterial coverage, and Azithromycin, for atypical mycoplasma pneumonia. Throughout his care, the patient remained on Trikafta and his AKI on admission was resolving upon discharge. Patient doing well in follow-up. Results NA Conclusion In 2024, during this patient’s presentation, the CDC noted a rise in M. pneumoniae infections. In vulnerable patients like those with CF, it is critical to investigate atypical pneumonia pathogens to initiate the correct treatment options. Early screening in vulnerable patients with PCR and other pathology techniques would be beneficial in treatment and outcomes.