The Association Between Smokeless Tobacco and a Lung Mass in a Healthy Young Male

Smokeless tobacco is widely used in the United States. Many commonly used forms of smokeless tobacco may contain microorganisms that can change the oral flora of tobacco users. Here we present a case of a previously healthy 21-year-old male who presented with six weeks of worsening cough productive of yellow sputum as well as pleuritic left-sided chest and back pain. Computed tomography (CT) of the chest showed a large 3.9 x 5.5 x 6.3 cm mass-like lesion. He was extensively worked up for potential causes of this mass, including autoimmune, HIV testing, sputum staining for acid-fast bacilli, and fungal serologies. He was empirically treated with antibiotics and antifungals. He ultimately underwent a CT-guided biopsy which was negative for malignancy and tuberculosis. The culture from the biopsy revealed 5,000 colony forming units of Streptococcus intermedius. Based on the sensitivities of the culture, he was switched to intravenous ceftriaxone and discharged to complete a course of intravenous antibiotics.  This case showcases a healthy 21-year-old male with no prior history who had an extensive workup for the possible causes and risk factors predisposing to a lung abscess. This workup was negative, and his only risk factor was the use of smokeless chewing tobacco. Smokeless tobacco may be associated with increased risk of lower respiratory tract infections and can increase the risk of lung abscess in an immunocompetent adult. More research is required to understand this association.