Propionibacterium acnes pleural empyema following medical thoracoscopy

Propionibacterium acnes (P. acnes) is a Gram-positive anaerobic rod and a common skin commensal that colonizes sebaceous glands. It has infrequently been associated with invasive opportunistic infections and can cause implant-associated infections through a biofilm mode of growth. Medical thoracoscopy is a common procedure for diagnosis and treatment of exudative pleural effusions; empyema is a recognized complication. We present a rare case of P. acnes pleural empyema 3 weeks following medical thoracoscopy and subsequent intercostal drain insertion for 3 days in a 75-year-old man. We postulate that pathogenesis may be associated with inoculation at the time of thoracoscopy or via biofilm formation on the intercostal drain. This case highlights the potential for this pathogen to cause clinically significant disease following thoracoscopy and pleural drainage.