Post-Traumatic Chest Wall Abscess Associated with Gordonia sputi in an Immunocompetent Patient: A Case Report

Gordonia species are rare aerobic Gram-positive actinomycetes and opportunistic pathogens. Their clinical manifestations and optimal management remain poorly defined. Gordonia sputi is an especially uncommon cause of soft-tissue and chest wall infections, and diagnosis is often delayed because of slow growth and difficulties in identification.

We report the case of a 45-year-old previously healthy man who presented with a progressively enlarging and painful mass on the left chest wall following blunt trauma. He was afebrile and had no systemic symptoms. Contrast-enhanced CT revealed a localized chest wall abscess, and surgical drainage was performed. Initial cultures from the 1st debridement were negative, but histopathological examination showed granulomatous inflammation with features suggestive of infection by an actinomycete-like organism. Because of wound dehiscence, a 2nd debridement was required. Microbiological examination of specimens obtained during the second procedure was positive on Kinyoun staining. Matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS) suggested G. sputi, and this identification was confirmed by 16S ribosomal RNA gene sequencing. Based on antimicrobial susceptibility testing, oral amoxicillin was administered for 6 months. The wound healed completely, and no recurrence was observed during 1 year of follow-up.

This case highlights the diagnostic challenges associated with G. sputi isolated from a post-traumatic chest wall abscess in an immunocompetent patient. Accurate diagnosis required a combination of histopathology, MALDI-TOF MS, and molecular identification. In addition, successful management required both adequate surgical drainage and prolonged, pathogen-directed antimicrobial therapy. Because the organism was isolated only after re-debridement and the initial culture was negative, the precise timing and causal role of G. sputi in the infection cannot be determined conclusively.