ABSTRACT
Lung abscesses are uncommon in the paediatric population, often manifesting with cough, shortness of breath, chest pain and fever. A high index of suspicion is imperative to prevent delays in treatment. This is a case report of a previously healthy child in early childhood with a 5-month history of recurrent left upper lobe (LUL) pneumonia. A foreign body was identified in the LUL and removed via flexible bronchoscopy. Following the foreign body removal, the patient developed a 9 cm lung abscess. A high index of suspicion for a lung abscess post-foreign body removal is important for early diagnosis and ensuring appropriate antibiotic coverage in patients with persistent fever. Intravenous antibiotics are essential in the management of lung abscesses. Consideration should be given to percutaneous drainage in situations where there is minimal improvement after 72 hours of suitable antimicrobial therapy or when the abscess exceeds 6 cm in size.
Subject(s)
Anti-Bacterial Agents , Bronchoscopy , Foreign Bodies , Lung Abscess , Humans , Lung Abscess/etiology , Foreign Bodies/complications , Foreign Bodies/surgery , Anti-Bacterial Agents/therapeutic use , Male , Drainage/methods , Child, Preschool , Tomography, X-Ray ComputedABSTRACT
BACKGROUND: Cold agglutination syndrome is a subtype of autoimmune hemolytic anemia. The condition is referred to as "cold" because the antibodies become active and induce hemolysis at cold temperatures, typically 3-4 °C, which is not always the case in other kinds of autoimmune hemolytic anemia. Whereas primary cold agglutination syndrome may occur in the absence of underlying conditions, secondary cold agglutination syndrome is associated with the presence of underlying infections, including coronavirus disease 2019. CASE PRESENTATION: We report the case of a 69-year-old Japanese woman with periodontitis who was referred to our hospital with complaints of brown-colored urine and chest pain. Her hemoglobin level was 6.1 g/dL. Computed tomography revealed multiple lung abscesses. Her direct antibody test results were positive (2+) for anti-complement direct antiglobulin and negative for immunoglobulin G, and her cold agglutinin titer was elevated at 1:4096. Workup for anemia revealed a positive result for cold agglutination syndrome. The patient had received the fourth dose of coronavirus disease 2019 vaccination. Nasopharyngeal swab test for detecting severe acute respiratory syndrome coronavirus 2 using a real-time reverse-transcription polymerase chain reaction gave a cycle threshold value of 42.3, and the level of virus-specific immunoglobulin G was elevated at 7.71 S/C (normal range -1.4 S/C). CONCLUSION: A decrease in hemoglobin in patients with coronavirus disease 2019 may be associated with secondary cold agglutination syndrome. The patient was hypothesized to have developed multiple lung abscesses with secondary cold agglutination syndrome following coronavirus disease 2019. Thus, following coronavirus disease 2019, patients can develop secondary cold agglutination syndrome, which could worsen owing to associated bloodstream bacterial infections.
Subject(s)
Anemia, Hemolytic, Autoimmune , COVID-19 , Lung Abscess , SARS-CoV-2 , Humans , Female , Aged , COVID-19/complications , COVID-19/diagnosis , Anemia, Hemolytic, Autoimmune/diagnosis , Anemia, Hemolytic, Autoimmune/etiology , Lung Abscess/etiology , Tomography, X-Ray ComputedABSTRACT
Congenital anomalies of respiratory system are quite diverse and not all of them are subject to surgical treatment. One example is accessory lobe of the azygos vein. This anomaly usually has no clinical manifestations and requires only follow-up, as well as attention in surgery on the right half of the chest for some other disease. This situation changes when complications occur, for example, purulent-inflammatory process. Therapy is not always effective, and lung tissue destruction requires surgical treatment. Progressive destruction complicates diagnosis and choosing surgical tactics. We present a rare case of severe purulent-inflammatory complication with abscess in accessory lobe of v. azygos. Anatomical abnormalities following this congenital pulmonary anomaly can cause difficulties in surgeries for other intra-thoracic diseases. The situation is especially relevant for thoracoscopic access. This report will be useful for radiologists, pulmonologists and thoracic surgeons.
Subject(s)
Azygos Vein , Humans , Azygos Vein/surgery , Azygos Vein/abnormalities , Treatment Outcome , Male , Tomography, X-Ray Computed/methods , Thoracoscopy/methods , Lung/surgery , Lung/abnormalities , Lung/blood supply , Lung/diagnostic imaging , Female , Lung Abscess/surgery , Lung Abscess/diagnosis , Lung Abscess/etiologyABSTRACT
BACKGROUND: Fusobacterium necrophorum is an anaerobic, gram-negative, non-motile, filamentous, non-spore forming bacillus found in the oral cavity, gastrointestinal tract, and female genital tract, responsible of a rare disease named Lemierre Syndrome, characterized by septic thrombophlebitis of the internal jugular vein, which mainly affects previously healthy adolescents and young adults; some risk factors are reported, as smoking or primary viral or bacterial infection leading to the disruption of mucosa. The syndrome originates commonly from an upper respiratory infection such as pharyngotonsillitis, acute otitis media, cervical lymphadenitis, sinusitis, or odontogenic abscess, and may result in multiorgan metastasis, more frequently leading to pulmonary complications, especially lung abscesses. CASE PRESENTATION: We describe two cases of adolescents with atypical Lemierre Syndrome evaluated in a tertiary care center, one with a confirmed infection by Fusobacterium necrophorum and one with a presumptive diagnosis based on clinical features, who developed lung abscesses needing a prolonged antibiotic course and hospitalization. Of interest, both were user of electronic cigarette, configuring a possible new risk factor. The proper diagnosis of Lemierre Syndrome is often difficult to establish, so a high degree of suspicion is needed, especially in the case of lung abscesses in otherwise healthy adolescents. CONCLUSION: The current study will contribute to providing insight into Lemierre Syndrome clinical presentation and management in adolescents, promoting awareness for a rare but potentially fatal disease. Moreover, it suggests a possible relationship between Lemierre syndrome and the use of electronic cigarette, that should be investigated by future studies.
Subject(s)
Electronic Nicotine Delivery Systems , Lemierre Syndrome , Lung Abscess , Thrombophlebitis , Young Adult , Humans , Female , Adolescent , Lemierre Syndrome/complications , Lemierre Syndrome/diagnosis , Lemierre Syndrome/microbiology , Lung Abscess/etiology , Lung Abscess/complications , Anti-Bacterial Agents/therapeutic useABSTRACT
OBJECTIVES: This study aimed to elucidate the outcomes of emergency salvage surgery following life-threatening events (serious haemorrhage and/or infections) among patients with lung cancer who had undergone chemo- and/or radiotherapy. MATERIALS AND METHODS: We analysed the data of patient from 2015 to 2020, retrospectively. The clinical characteristics, including preoperative treatment, perioperative outcomes and survival time, were analysed. RESULTS: Of the 862 patients who underwent primary lung cancer surgeries, 10 (1.2%) underwent emergency surgeries. The preoperative clinical characteristics were: median age, 63.7 years [interquartile range (IQR) 55-70.5]; sex (male/female), 9/1; clinical staging before initial treatment (I/II/III/IV), 1/1/3/5; initial treatment (chemoradiotherapy/chemotherapy/proton beam therapy), 5/4/1; and indications for emergency surgery (lung abscess/lung abscess with haemoptysis/haemoptysis/empyema), 5/3/1/1. The selected procedures and results were as follows: lobectomy/bilobectomy/pneumonectomy, 8/1/1 (all open thoracotomies); median operation time, 191.0 min (IQR 151-279); median blood loss, 1071.5 ml (IQR 540-1691.5); postoperative severe complications, 3 (30%); hospital mortality, none; median postoperative hospital stay, 37 days (12-125); control of infection and/or haemoptysis, all the cases; final outcome (alive/dead), 3/7 (all the cancer deaths); median postoperative survival, 9.4 months (IQR 4.3-20.4); and median survival from initial treatment, 19.4 months (IQR 8.0-66.9). CONCLUSIONS: Emergency salvage lung resection is a technically challenging procedure; however, the results were feasible and acceptable when the surgical indication, procedure and optimal timing were considered carefully by a multidisciplinary team. Although the aim was palliation, some patients who received additional chemotherapy afterwards and, thus, had additional survival time.
Subject(s)
Carcinoma, Non-Small-Cell Lung , Lung Abscess , Lung Neoplasms , Carcinoma, Non-Small-Cell Lung/surgery , Female , Hemoptysis , Humans , Lung/pathology , Lung Abscess/etiology , Lung Neoplasms/surgery , Male , Middle Aged , Neoplasm Staging , Pneumonectomy/methods , Retrospective Studies , Salvage Therapy/adverse effects , Salvage Therapy/methods , Treatment OutcomeABSTRACT
BACKGROUND: Granulicatella adiacens is facultative anaerobic Gram-positive bacteria, which mainly involve bacterial endocarditis and bacteremia, but there are few reports of local suppurative infection. A case of lung abscess with a coinfection of Granulicatella adiacens and other bacteria in a lung cancer patient will be reported in this paper. To our knowledge, this is the first case report describing lung abscess due to G.adiacens. CASE PRESENTATION: A 52-year-old Chinese woman was admitted to the hospital, She complained of coughing and expectoration for 1 month, shortness of breath for half a month, and dyspnea for 1 day. After a series of examinations, she was diagnosed with lung abscess, pleural effusion, and bronchogenic carcinoma. Draining pus culture demonstrated Granulicatella adiacens. After more than 5 weeks of antibiotic therapies in total, she gradually recovered to fight against lung cancer. CONCLUSION: This is the first reported lung abscess caused by G.adiacens. In immunosuppressed hosts, G.adiacens is a virulent pathogen associated with a spectrum of intrathoracic suppurative. Earlier diagnosis and proper drainage surgery with effective antibiotics treatment are very important, and antimicrobial treatment should be more than 5 weeks. When complex pulmonary infection interferes with the CT diagnosis, clinical suspicion of lung cancer should be increased if G.adiacens or Eikenella corrodens is detected from a pulmonary infection.
Subject(s)
Carnobacteriaceae/pathogenicity , Coinfection/etiology , Lung Abscess/etiology , Lung Neoplasms/complications , Anti-Bacterial Agents/therapeutic use , Carnobacteriaceae/isolation & purification , Coinfection/diagnosis , Coinfection/drug therapy , Eikenella corrodens/isolation & purification , Eikenella corrodens/pathogenicity , Female , Humans , Lung Abscess/diagnosis , Lung Abscess/drug therapy , Lung Neoplasms/diagnosis , Lung Neoplasms/drug therapy , Middle Aged , Treatment OutcomeABSTRACT
Acquired esophago-respiratory fistulae are usually esophago-tracheal or esophago-bronchial. Esophago-pulmonary fistulae are rare. Most patients present with cardinal symptoms of esophageal carcinoma or esophago-pulmonary fistula leading to early diagnosis. We report a 56-year-old female with an unusual presentation. She presented with high grade fever with chills and rigor, cough with mucopurulent expectoration and shortness of breath for 15 days without dysphagia, nausea, vomiting or chest pain. Clinically and radiologically a diagnosis of lung abscess was entertained and she was treated with multiple antibiotics without any improvement. Contrast Enhanced Computed Tomography (CECT) chest revealed esophageal malignancy with esophageal-pulmonary fistula communicating with abscess cavity. Patient responded to palliation with self-expandable esophageal stent and drainage of abscess. Although rare, asymptomatic malignant esophageal disease should be considered in the differential diagnosis of lung abscess, which does not follow a usual course. Keywords: Lung abscess, Esophageal cancer, Esophageo-pulmonary fistula, Self expandable metallic stent.
Subject(s)
Esophageal Fistula , Esophageal Neoplasms , Lung Abscess , Respiratory Tract Fistula , Esophageal Fistula/diagnostic imaging , Esophageal Fistula/etiology , Esophageal Neoplasms/complications , Female , Humans , Lung Abscess/diagnostic imaging , Lung Abscess/etiology , Middle Aged , Respiratory Tract Fistula/diagnostic imaging , Respiratory Tract Fistula/etiology , Respiratory Tract Fistula/therapyABSTRACT
We report the case of a lung abscess due to Prevotella baroniae with a co-infection by Abiotrophia defective, which is a 'nutritionally variant streptococci' (NVS), in a 48-year-old patient. The delayed diagnosis of this co-infection led to multiple failures of medical treatment and need for surgery. Pathogenicity of these bacteria is well known, particularly in endocarditis, but not in lung infection. In pulmonary abscesses, co-infection with NVS is difficult to detect. It may explain some medical treatment failures. This case highlights the importance to systematically search for and consider NVS in such clinical contexts.
Subject(s)
Abiotrophia/isolation & purification , Coinfection , Delayed Diagnosis/adverse effects , Endocarditis, Bacterial/etiology , Gram-Positive Bacterial Infections/etiology , Lung Abscess/etiology , Lung/diagnostic imaging , Endocarditis , Endocarditis, Bacterial/diagnosis , Endocarditis, Bacterial/microbiology , Gram-Positive Bacterial Infections/diagnosis , Gram-Positive Bacterial Infections/microbiology , Humans , Lung/microbiology , Lung Abscess/diagnosis , Lung Abscess/microbiology , Male , Middle Aged , Tomography, X-Ray ComputedABSTRACT
BACKGROUND: Glomerular disease patients have a high risk of infection, which contributes to the progression of disease per se and mortality, especially in those with long-term use of glucocorticoids and (or) immunosuppressive agents. Cases of sporadic nocardiosis have been reported in glomerular disease patients, and this observation was conducted to comprehensively understand the manifestations of and treatments for nocardiosis, which is commonly misdiagnosed as pneumonia or tuberculosis or even as lung cancer or metastatic tumors in glomerular disease patients. METHODS: We reviewed the demographic characteristics, laboratory abnormalities, radiological features, and treatments of 7 patients with nocardiosis and glomerular disease receiving steroids and immunosuppression therapy at the nephrology department of the Second Xiangya Hospital between 2012 and 2019. RESULTS: It was found that all 7 patients had been receiving methylprednisolone for renal disease at a median dose of 20 mg per day and a median duration of 4 months before developing nocardiosis. There were 4 males and 3 females, and the median age was 52.14 years. All 7 patients had hypoalbuminemia at the time of admission. In addition, various cystic abscesses in the subcutaneous tissue, with or without lung and brain involvement, were observed in these patients. Encouragingly, body temperatures returned to normal, and subcutaneous abscesses diminished or disappeared with compound sulfamethoxazole treatment alone or in combination with linezolid, imipenem and mezlocillin/sulbactam. CONCLUSIONS: It was shown that multisite abscesses, including subcutaneous, pulmonary and cerebral abscesses, were the common manifestations of nocardiosis in glomerular disease patients. Sulfonamide was the first-line antibiotic therapy for nocardiosis, and combinations of other antibiotics were also needed in some serious cases.
Subject(s)
Abscess/etiology , Glomerulonephritis/complications , Glucocorticoids/adverse effects , Immunocompromised Host , Immunosuppressive Agents/adverse effects , Nocardia Infections/etiology , Abscess/drug therapy , Aged , Anti-Bacterial Agents/therapeutic use , Brain/diagnostic imaging , Brain Abscess/diagnostic imaging , Brain Abscess/etiology , Female , Glomerulonephritis/drug therapy , Glucocorticoids/therapeutic use , Humans , Immunosuppressive Agents/therapeutic use , Lung/diagnostic imaging , Lung Abscess/diagnostic imaging , Lung Abscess/etiology , Magnetic Resonance Imaging , Male , Middle Aged , Nocardia Infections/diagnosis , Nocardia Infections/diagnostic imaging , Sulfonamides/therapeutic use , Tomography, X-Ray ComputedABSTRACT
A 25-year-old man was admitted to our institution for remission induction therapy to treat a 12-year condition of ulcerative colitis (UC). Previously, he was treated with drugs, such as mesalamine, immunomodulators, prednisolone (PSL), and anti-TNFα anti-body, but remission was not maintained. Therefore, we started remission induction therapy with 20 mg/day of tofacitinib (TOF) to inhibit the action of Janus kinase. On the 29th day after TOF administration, he developed a lung abscess with high fever. A chronic bulla was already present in his lung; therefore, the lung abscess was likely formed due to a combination of the bulla being present and the pharmacological effects of TOF. Our report is significant as it highlights the compounding association between TOF and PSL therapy and bulla presence with the rare adverse effect of developing an abscess.
Subject(s)
Colitis, Ulcerative , Lung Abscess , Adult , Anti-Inflammatory Agents, Non-Steroidal/therapeutic use , Colitis, Ulcerative/drug therapy , Humans , Immunosuppressive Agents/adverse effects , Lung Abscess/drug therapy , Lung Abscess/etiology , Male , Mesalamine/therapeutic use , Remission InductionSubject(s)
COVID-19/complications , Lung Abscess/etiology , Anti-Bacterial Agents/administration & dosage , COVID-19/pathology , COVID-19/therapy , Disease Progression , Drug Therapy, Combination , Female , France , Humans , Lung Abscess/diagnosis , Lung Abscess/drug therapy , Middle Aged , Obesity/complications , Obesity/pathology , Opportunistic Infections/diagnosis , Opportunistic Infections/drug therapy , Opportunistic Infections/etiology , Pneumonia, Viral/complications , Pneumonia, Viral/pathology , Pneumonia, Viral/therapy , SARS-CoV-2/physiology , Time FactorsABSTRACT
Pulmonary infection is a relatively rare but serious complication of flexible bronchoscopy. The aim of this study was to identify the risk factors for pulmonary infectious complications after diagnostic bronchoscopy in patients with lung cancer. We retrospectively analyzed the medical records of 636 patients who underwent bronchoscopic biopsy for lung cancer diagnosis between April 2011 and March 2016. We compared patients' characteristics, chest computed tomography and bronchoscopic findings, undertaken procedures, and final diagnoses between patients who developed the complication and those who did not. Pulmonary infection after the diagnostic bronchoscopy occurred in 19 patients (3.0%) and included pneumonia in 16 patients and lung abscess in 3. Patients with larger lesions, presence of endobronchial lesions, histology of small cell lung cancer, and advanced disease stage tended to develop pulmonary infectious complications more often. Our multivariate analysis revealed that a larger lesion size and the presence of endobronchial lesions were independently associated with post-bronchoscopy pulmonary infection. Although we found no mortality associated with the infections, two patients were left with significant performance status deterioration after the pulmonary infection and received no anticancer treatment. In conclusion, endobronchial lesions and a larger lesion size are independent risk factors for the incidence of infections following bronchoscopic biopsy in patients with lung cancer.
Subject(s)
Bronchoscopy/adverse effects , Lung Abscess/etiology , Lung Neoplasms/pathology , Pneumonia/etiology , Adult , Aged , Aged, 80 and over , Biopsy/adverse effects , Female , Humans , Lung Abscess/diagnosis , Male , Middle Aged , Pneumonia/diagnosis , Predictive Value of Tests , Retrospective Studies , Risk Assessment , Risk FactorsABSTRACT
Background: The management of lung abscess may be a challenge in elderly patients undergoing chemotherapy and/or radiotherapy for previous malignancy. Herein, we reported a case series of elderly patients with previous lymphoma undergoing endoscopic treatment followed by pulmonary rehabilitation for lung abscess. Methods: Our study population included a consecutive series of elderly patients with previous lymphoma and lung abscess. Suppurative infection was refractory with specific antibiotic therapy. In all cases, drainage was endoscopically inserted in lung abscess via video-bronchoscopy. This strategy allowed performing daily therapy with the installation of gentamicin directly into the abscess cavity. All patients underwent a respiratory rehabilitation program to speed up convalescence and allow early discharge. Results: After positioning the catheter through a bronchoscopic route and subsequent washing with gentamicin, all the patients in our study showed an improvement in clinical conditions with resolution of fever within a few days of starting the procedure with normalization of blood tests (mean hospital length 7 ± 0.73 days). A follow-up chest computed tomography scan showed a resolution of lung abscess within a mean of 27 ± 1.53 days. Conclusions: Endoscopic treatment with a rehabilitation program may be a valuable strategy for the management of lung abscess that is refractory to standard antibiotic therapy. Further and larger studiesshould be done to confirm our results.
Subject(s)
Bronchoscopy/methods , Lung Abscess/etiology , Lung Abscess/surgery , Lymphoma/complications , Respiratory Therapy/methods , Aged , Anti-Bacterial Agents/therapeutic use , Female , Humans , Male , Middle Aged , Tomography, X-Ray ComputedSubject(s)
AIDS-Related Opportunistic Infections/diagnosis , Lung Abscess/diagnostic imaging , Lung Abscess/etiology , AIDS-Related Opportunistic Infections/drug therapy , AIDS-Related Opportunistic Infections/immunology , AIDS-Related Opportunistic Infections/microbiology , Administration, Intravenous , Anti-Bacterial Agents/administration & dosage , Anti-Bacterial Agents/therapeutic use , Diagnosis, Differential , Humans , Immunocompromised Host , Injections, Intramuscular , Lung Abscess/drug therapy , Lung Abscess/microbiology , Male , Middle Aged , Tomography, X-Ray Computed , Treatment OutcomeABSTRACT
BACKGROUND: Pulmonary valve infective endocarditis is a rare diagnosis that is usually associated with immunocompromised states or structurally abnormal hearts. It is unusual for it to occur in structurally normal hearts or to cause recurrent symptoms after targeted antibiotics. Although guidelines suggest follow-up with repeat echocardiography and inflammatory marker surveillance, this case demonstrates that these are not always useful investigations, and instead imaging of the chest may be more appropriate. CASE PRESENTATION: We describe a case of a 74-year-old man who presented with respiratory symptoms and was originally misdiagnosed with pneumonia but later found to have a large pulmonary valve vegetation caused by Streptococcus mitis. Despite initially responding to antibiotic therapy, the vegetation continued to cause pulmonary emboli and cavitating lung abscesses months later, necessitating pulmonary valve replacement. CONCLUSIONS: This case demonstrates that pulmonary valve endocarditis can present atypically with recurrent respiratory symptoms, and in such cases, echocardiography should be considered to investigate for right-sided infective endocarditis. In addition, despite correct treatment, with normalization of inflammatory markers and improvement in vegetation size, infective endocarditis can continue to cause systemic symptoms. Finally, clinicians should consider chest computed tomography routinely as part of right-sided infective endocarditis follow-up.
Subject(s)
Delayed Diagnosis/adverse effects , Endocarditis, Bacterial/diagnostic imaging , Pulmonary Valve/diagnostic imaging , Aged , Anti-Bacterial Agents/therapeutic use , Echocardiography , Endocarditis, Bacterial/complications , Endocarditis, Bacterial/drug therapy , Endocarditis, Bacterial/microbiology , Humans , Lung Abscess/diagnostic imaging , Lung Abscess/etiology , Male , Pulmonary Embolism/diagnostic imaging , Pulmonary Embolism/etiology , Pulmonary Valve/microbiology , Pulmonary Valve/surgery , Streptococcus mitis/isolation & purification , Tomography, X-Ray ComputedABSTRACT
RATIONALE: Necrotizing pneumonia is characterized by destruction and liquefaction of the lung tissue and loss of the normal pulmonary parenchymal architecture. During the course of resolution areas of hyperlucency are formed, sometimes with the development of giant lung cysts that can be a field with fluid resembling lung abscess. There is no consensus on the management of these abnormalities. OBJECTIVE: To assess the prevalence of giant lung cysts as a complication of necrotizing pneumonia and to report our experience with conservative treatment that achieved complete resolution. METHODS: Medical chart reviews of all children aged 0 to 18 years hospitalized with necrotizing pneumonia in a single tertiary center from 2015 to 2017, demographic data, and clinical course during and after hospitalization as well as serial chest imaging were collected. RESULTS: During the study period, 761 children were diagnosed with community-acquired pneumonia, 16 of 761 (2.3%) had necrotizing pneumonia and 6 of 16 (37.5%) with necrotizing pneumonia complicated by a giant lung cyst or lung abscess. All were closely observed and showed complete clinical and radiographic resolution with antibiotic treatment. CONCLUSIONS: Treatment of giant lung cyst formation following necrotizing pneumonia by a conservative approach with prolonged antibiotics results in complete recovery with no need for invasive procedures.
Subject(s)
Conservative Treatment , Cysts/etiology , Lung Abscess/etiology , Lung Diseases/etiology , Pneumonia, Necrotizing/complications , Anti-Bacterial Agents/therapeutic use , Child, Preschool , Cysts/diagnosis , Cysts/therapy , Female , Humans , Infant , Lung Abscess/diagnosis , Lung Abscess/therapy , Lung Diseases/diagnosis , Lung Diseases/therapy , Male , Necrosis , Pneumonia, Necrotizing/therapy , Radiography, Thoracic , Retrospective StudiesABSTRACT
BACKGROUND: Only 4.1% of tricuspid valve IE cases require surgical intervention. The complication after tricuspid valve IE with lung abscess and empyema is rare. CASE PRESENTATION: We report the case of a 38-year-old male (an intravenous drug abuser) diagnosed with tricuspid valve IE who underwent tricuspid valve replacement. The case was complicated by multiple lung abscesses and thoracic empyema. The pathogens causing the lung abscesses and empyema were Acinetobacter baumannii complex and Candida albicans, which were different from those causing the endocarditis. After 4 weeks of antibiotic treatment, chest X-ray revealed bilateral clear lung markings with only mild blunting of the right costophrenic angle. CONCLUSION: The pathogen causing the lung abscess is not always compatible with that causing the endocarditis. Thoracoscopic incision of the abscess with 4 to 6 weeks of broad-spectrum antibiotic treatment is effective and safe.
Subject(s)
Empyema, Pleural/microbiology , Endocarditis, Bacterial/microbiology , Lung Abscess/microbiology , Substance Abuse, Intravenous/microbiology , Tricuspid Valve/surgery , Acinetobacter Infections/drug therapy , Acinetobacter Infections/microbiology , Acinetobacter Infections/surgery , Acinetobacter baumannii/isolation & purification , Adult , Anti-Bacterial Agents/therapeutic use , Candida albicans/isolation & purification , Candidiasis/drug therapy , Candidiasis/microbiology , Candidiasis/surgery , Empyema, Pleural/drug therapy , Empyema, Pleural/etiology , Empyema, Pleural/surgery , Endocarditis, Bacterial/drug therapy , Endocarditis, Bacterial/surgery , Heart Valve Prosthesis Implantation , Humans , Lung Abscess/drug therapy , Lung Abscess/etiology , Lung Abscess/surgery , Male , Staphylococcal Infections/drug therapy , Staphylococcal Infections/microbiology , Staphylococcal Infections/surgery , Staphylococcus aureus/isolation & purification , Substance Abuse, Intravenous/complications , Thoracoscopy , Tricuspid Valve/microbiologyABSTRACT
We discuss the case of a 44-year-old man with a refractory left lower lobe pneumonia progressing to a pulmonary abscess caused by a colobronchial fistula, a rare complication of underlying Crohn's disease. The patient presented with weight loss and signs of a pulmonary consolidation, which responded incompletely to the targeted antibiotic treatment. The causative colobronchial fistula was demonstrated by CT-guided puncture and retrograde injection of contrast medium. After fistula excision, the patient recovered rapidly with a weight gain of 4 kg within a few weeks.