Up in Smoke: A Rare Case of Hookah-Induced Streptococcus Viridans Pneumonia

T. Kukkadapu1, L. Jia2, J. Keshavamurthy2, J. N. Gonzales3;

Author address: 

1Pulmonary Medicine and Critical Care, Augusta University Medical Center, Augusta, GA, United States, 2Augusta University Medical Center, Augusta, GA, United States, 3Pulmonary/Critical Care/Vascular Biology, Georgia Regents Univ., Augusta, GA, United States.


Introduction: Cavitary lung lesions on chest radiography carry a broad differential diagnosis. Often, the workup for infectious cause returns fruitless and the patient’s clinical course may be the sole clue in making the diagnosis. Here, we present a rare case of hookah-induced Streptococcus viridanspneumonia.
Case Report: A 59-year-old woman presented with acute development of productive cough, and fever for five days. Her cough produced yellow, foul-smelling sputum with specks of blood. She denied weight loss or night sweats but reported recent travel to Florida and multiple instances of hookah use during that trip. Physical examination revealed bilateral inspiratory crackles. Laboratory investigations showed leukocytosis (16K/mL). Initial CXR showed multiple bilateral cavitary lesions (red arrow marks) and subsequent computed tomography (CT) of chest revealed multiple large cavitary lesions in both upper lobes with sub-millimetermicro nodules (red arrow marks) concerning for necrotic multifocal pneumonia particularly with anaerobic organisms, lung abscess, pulmonary necrotizing aspergillus or mycobacterium infections. Patient was started on empiric antibiotic therapy. Mycobacterium tuberculosis PCR returned negative. Routine blood cultures and fungal cultures did not grow any organisms. Sputum culture was positive for alpha-hemolytic Streptococcus viridans. Five days later, the patient improved and was discharged on antibiotics. Follow-up chest x-ray after 3 weeks confirmed resolving cavitary lesions.
Discussion: Despite rising popularity, hookah use is not benign and has been implicated in myriad of pulmonary manifestations less commonly pulmonary abscesses, also known to cause carbon monoxide poisoning and carcinogenesis, the main route of transmission is through sharing of hookah equipment causing spread of infectious agents. The shared mouthpiece and water basin have been reported as vectors for fungal and bacterial pulmonary infections. This case highlights the importance of history taking in making accurate diagnosis and need for education in community regarding deleterious effects of hookah use. Though previous cases of Streptococcal viridans pulmonary infections have been reported in the literature as causes of pulmonary abscesses and pleural empyema, it is an often-overlooked cause of primary pneumonia. 



abstract No: 

A3595 / P14

Full conference title: 

The American Thoracic Society Conference 2018
    • ATS 2018