A Rare Case of Escherichia coli Chest Wall Abscess With Rib Osteomyelitis in a Patient With Crohn’s Disease

Abstract

Primary chest wall abscess due to hematogenous spread is very rare and has seldom been documented in the literature, with most reported cases attributed to Mycobacterium tuberculosis. Prompt diagnosis and management with antibiotics, and evacuation of the abscess, is imperative as the infection can lead to systemic or disseminated infection, including erosion into surrounding bone if left untreated. We describe the case of a 67-year-old female with severe Crohn's disease receiving anti-tumor necrosis factor-alpha (TNF-α) therapy, Etanercept presenting with localized Escherichia coli (E. coli) chest wall abscess with erosion into the surrounding rib. This case highlights a rare clinical entity, chest wall abscess, which is also an unusual site of E. coli infection. Only three previous cases of E. coli primary chest wall abscess can be found in the published literature. This case also highlights a possible association of severe Crohn's disease predisposing to complicated soft tissue infection.

Role of adherent invasive Escherichia coli in pathogenesis of inflammatory bowel disease

“…CD-associated AIEC has been found to invade several human epithelial cell lines in vitro , including HEP-2 cells and the INT 407, CACO-2, and HCT-8 IEC cell lines. AIEC survived and replicated successfully in the cytoplasm of host cells[ 69 ]. The main virulence factors in CD-related AIEC are type 1 pili, which induce membrane extension; flagella, which endow bacteria with mobility; effector molecules, which enable AIEC to interact with host cell outer membrane vesicles; and Omp C, which regulates bacterial virulence factors through sigma signaling.…”