Brevundimonas diminuta-Induced Lung Abscess in an Immunocompetent Adult: A Rare Case Report.

Lung abscesses caused by Brevundimonas diminuta (B. diminuta) are a rare occurrence, particularly in immunocompetent adults. We present the case of a 47-year-old male with a history of COPD, bipolar disorder, and seizure disorder, who presented with a productive cough, worsening shortness of breath, yellow sputum, weight loss, and fatigue over a period of three weeks. Clinical examination revealed decreased breath sounds in the left upper lung zones. Laboratory investigations showed an elevated white cell count, while blood cultures identified B. diminuta. Imaging with computed tomography (CT) confirmed the presence of a 4.2x2.0 cm cavitary lesion consistent with a lung abscess. The patient was successfully treated with a combination of Ampicillin/Sulbactam and Azithromycin, followed by a course of oral Augmentin. Given the size of the abscess and favorable response to antibiotic therapy, invasive procedures were deemed unnecessary. This case underscores the importance of considering unusual pathogens in the etiology of lung abscesses, even in immunocompetent individuals, and highlights the successful management with appropriate antibiotic therapy.

Pneumothorax Ex Vacuo: A Rare Complication of PleurX Catheter Insertion.

Pneumothorax ex vacuo (PEV) is a rare type of pneumothorax that occurs when air enters the pleural space in the chest cavity due to an increase in the volume of the lungs or a reduction in the volume of the surrounding lung tissue. Unlike a typical pneumothorax, which involves the collapse of the lung due to air accumulation, pneumothorax ex vacuo occurs when the lung itself cannot expand properly, often due to underlying lung disease or conditions such as pulmonary fibrosis or atelectasis. The mechanism is compensatory to the lung entrapment. PleurX catheter (Pleur-Evac; Teleflex, Wayne, PA, USA) insertion can cause pneumothorax ex vacuo in patients with cancer histories, as shown in this case. It is important to understand if pneumothorax ex vacuo needs observation or quick intervention. Pleural manometry is also an important part of diagnosis of pneumothorax ex vacuo and we discuss that in our case report.