Clostridioides difficile recovered in pleural fluid: Contamination or infection? A case report of a proven empyema and a literature review

Introduction: Pleural empyema is an infrequent manifestation of extraintestinal Clostridioides difficile infection, with just eight cases reported in literature.Methods: We report a new case in a 70-year-old male without comorbidities or evidence of concomitant gastrointestinal disease, and review the previous cases reported in the literature.Results: The isolate was susceptible to all antimicrobial tested and was negative for A + B toxins. The patient fully recovered after drainages and antimicrobial therapy with amoxicillin-clavulanate and doxy-cycline.Conclusion: As in the previously reported cases, aspiration was the most plausible hypothesis of mechanism of infection in our patient. Empyema by Clostridioides difficile is a diagnostic challenge, since it is necessary to rule out that the isolation of this microorganism in pleural fluid is not a contamination. Furthermore, more evidence is needed for its treatment since data regarding this entity are still scarce.(c) 2022 Sociedad Espanola de Enfermedades Infecciosas y Microbiologia Clinica. Published by Elsevier Espana, S.L.U. All rights reserved.