• Min Wang, Qianfeng Xiao, and Kaige Wang.
• Department of Pulmonary and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, China.
• Medicine (Baltimore). 2024 Feb 2; 103 (5): e37003e37003.

RationaleActinomyces odontolyticus causes a rare, chronic granulomatous infection that is frequently associated with immunocompromised states. A odontolyticus can cause infection in multiple organs, but empyema is rare.Patient ConcernsWe report a case of empyema caused by A odontolyticus. The patient was a 64-year-old man. He was admitted to the hospital with a 5-day history of fever and dyspnea. He had caries and sequelae of cerebral apoplexy.DiagnosesMetagenome next generation sequencing of pleural effusion was positive for A odontolyticus. Pathogen was identified by biphasic culture of pleural effusion fluid.InterventionsAccording to the drug sensitivity test, linezolid 0.6 g twice daily and clindamycin 0.6 g 3 times a day were administered intravenously. Thoracic drainage was initially performed, but the drainage was not sufficient. Medical thoracoscopy was performed to fully drain the pleural effusion.OutcomesAfter anti-infection and medical thoracoscopic therapy, the symptoms of this patient improved.LessonsMicrobial metagenome sequencing can find pathogens that are difficult to culture by traditional methods. Adequate drainage was the key to the treatment of empyema. Medical thoracoscopy was recommended to remove the pleural effusion and spoilage when thoracic drainage is difficult. The common clinical features of A odontolyticus include a mass or swelling, abdominal disease, dental disease, and subcutaneous abscesses. Microbial metagenome sequencing can find pathogens that are difficult to culture by traditional methods. Adequate drainage was the key to the treatment of empyema. Medical thoracoscopy was recommended to remove the pleural effusion and spoilage when thoracic drainage is difficult.Copyright © 2024 the Author(s). Published by Wolters Kluwer Health, Inc.

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