Posters
Academic Level (Author 1)
Resident
Discipline/Specialty (Author 1)
Internal Medicine
Academic Level (Author 2)
Resident
Discipline/Specialty (Author 2)
Internal Medicine
Discipline/Specialty (Author 3)
Internal Medicine
Academic Level (Author 4)
Resident
Discipline/Specialty (Author 4)
Internal Medicine
Academic Level (Author 5)
Resident
Discipline/Specialty (Author 5)
Internal Medicine
Discipline Track
Patient Care
Abstract
Background Community-acquired pneumonia (CAP) is a leading cause of hospitalizations, and due to its diverse disease presentation, determining appropriate level of treatment is essential. CAP can lead to different complications, including necrotizing pneumonia. Due to its high morbidity and mortality rates, necrotizing pneumonia is critical to rapidly identify and treat accordingly. Therefore, we present a case of a young patient who presented with necrotizing pneumonia after failing CAP outpatient therapy.
Case Presentation A 42-year-old Hispanic lady with past medical history of hypertension and hyperlipidemia presented to the emergency department with 6-day history of right upper quadrant pain, associated with fever, productive cough and chills. Patient was seen by her primary doctor, who prescribed her antibiotics which she fails to recall. Due to worsening of symptoms, she decided to come to the hospital. Vital signs revealed T 99.6, heart rate of 89 bpm, respiratory rate of 16, blood pressure 124/64 mm Hg and SpO2 of 96% on room air. Physical exam was remarkable to decreased right lung sounds with increased egophony ipsilateral. Chest x-ray on admission revealed multifocal pneumonic infiltrate, most predominant in the right lower lobe. Blood and sputum cultures were sent, and broad-spectrum antibiotics were started. Blood cultures were positive for multidrug resistant S. pneumoniae. Due to persistence of symptoms and non-resolving imaging findings, CT of the chest was ordered and revealed necrotizing pneumonia with abscess formation in the right lung with complex right pleural effusion. Cardiothoracic surgery was consulted, and patient underwent successful right lung decortication. The patient overall improved her symptoms and was later discharged with oral antibiotics and close follow up.
Conclusion Necrotizing pneumonia can rapidly progress to septic shock and respiratory failure, therefore being critical to promptly identify for proper course of treatment. Chest radiographs often underestimates the degree of parenchymal destruction therefore, chest CT with contrast is required for making the diagnosis. Besides the use of intravenous antibiotics, surgical interventions can be considered in patients who fail medical therapy or present new parapneumonic effusions, both presented by our patient.
Presentation Type
Poster
Recommended Citation
Montes, Sonya R.; Gomez Casanovas, Jose Gerardo; Rincon-Rueda, Laura; Bartl, Mery; and Fleires, Alcibiades, "Necrotizing Pneumonia from MDR S.pneumoniae in a Young Patient: A Case Report" (2024). Research Colloquium. 42.
https://scholarworks.utrgv.edu/colloquium/2023/posters/42
Included in
Necrotizing Pneumonia from MDR S.pneumoniae in a Young Patient: A Case Report
Background Community-acquired pneumonia (CAP) is a leading cause of hospitalizations, and due to its diverse disease presentation, determining appropriate level of treatment is essential. CAP can lead to different complications, including necrotizing pneumonia. Due to its high morbidity and mortality rates, necrotizing pneumonia is critical to rapidly identify and treat accordingly. Therefore, we present a case of a young patient who presented with necrotizing pneumonia after failing CAP outpatient therapy.
Case Presentation A 42-year-old Hispanic lady with past medical history of hypertension and hyperlipidemia presented to the emergency department with 6-day history of right upper quadrant pain, associated with fever, productive cough and chills. Patient was seen by her primary doctor, who prescribed her antibiotics which she fails to recall. Due to worsening of symptoms, she decided to come to the hospital. Vital signs revealed T 99.6, heart rate of 89 bpm, respiratory rate of 16, blood pressure 124/64 mm Hg and SpO2 of 96% on room air. Physical exam was remarkable to decreased right lung sounds with increased egophony ipsilateral. Chest x-ray on admission revealed multifocal pneumonic infiltrate, most predominant in the right lower lobe. Blood and sputum cultures were sent, and broad-spectrum antibiotics were started. Blood cultures were positive for multidrug resistant S. pneumoniae. Due to persistence of symptoms and non-resolving imaging findings, CT of the chest was ordered and revealed necrotizing pneumonia with abscess formation in the right lung with complex right pleural effusion. Cardiothoracic surgery was consulted, and patient underwent successful right lung decortication. The patient overall improved her symptoms and was later discharged with oral antibiotics and close follow up.
Conclusion Necrotizing pneumonia can rapidly progress to septic shock and respiratory failure, therefore being critical to promptly identify for proper course of treatment. Chest radiographs often underestimates the degree of parenchymal destruction therefore, chest CT with contrast is required for making the diagnosis. Besides the use of intravenous antibiotics, surgical interventions can be considered in patients who fail medical therapy or present new parapneumonic effusions, both presented by our patient.