Unravelling the unusual: Enterococcus faecium in aspiration pneumonia complicated with lung abscess in a severely comorbid patient

Aspiration pneumonia is a common respiratory infection that can lead to complications, including lung abscess. While typical causative agents include P. aeruginosa, K. pneumoniae, and S. aureus, atypical agents must also be considered, especially in comorbid or elderly populations. This case report presents a rare instance of aspiration pneumonia caused by E. faecium that developed into a lung abscess in a patient with multiple comorbidities. The patient's medical history included left-sided hemiparesis, hypertension, and type-2 diabetes mellitus, as well as a thirty-year history of smoking and alcoholism. Radiological evaluation revealed a rounded opacity with an air-fluid level in the left lower zone, indicating a lung abscess. Microbiological evaluation confirmed the presence of Enterococcus spp. The case highlights the importance of considering atypical pathogens in aspiration pneumonia and the potential for severe complications in severely comorbid patients.

Diagnóstico por imagen de abscesos hepáticos y pulmonares por estreptococos del grupo viridans. Presentación de caso / Imaging diagnosis of liver and lung abscesses due to viridans streptococci. Case presentation

Resumen El Streptococcus viridans es conocido más comúnmente como agente infeccioso en las endocarditis, sin embargo, poco se conoce sobre su potencial infeccioso en otros órganos o sistemas, donde ha demostrado una elevada mortalidad. El reconocimiento del Streptococcus viridans como agente productor de abscesos en otras localizaciones como a nivel hepático o pulmonar, permitirá un diagnóstico oportuno mediante los distintos métodos de imagen, reduciendo las graves consecuencias para el paciente y los tiempos de hospitalización. Se presenta el caso de un paciente del sexo masculino de 33 años de edad sin antecedentes crónico degenerativos, que inició con sintomatología 7 meses previos a su ingreso, con fiebre intermitente, fatiga, astenia, anorexia y pérdida de peso. A la exploración física presentó dolor a la palpación media y profunda en hipocondrio derecho, en el panel de laboratorios presentó llamativa neutrofilia, en la tomografía de tórax y abdomen se mostró lesión cavernomatosa en pulmón y quistes complicados hepáticos, a los cuales se les realizó drenaje percutáneo guiado por ultrasonido, con envío de muestras a cultivo con resultado positivo para Streptococcus viridans, lo que permitió brindar el tratamiento dirigido al paciente, y que remitiera la enfermedad.

Abstract Streptococcus viridans is more commonly known as an infectious agent in endocarditis, however, little is known about its infectious potential in other organs or systems, where it has shown high mortality. The recognition of Streptococcus viridans as an abscess-producing agent in other locations, such as the liver or lungs, will allow timely diagnosis using different imaging methods, reducing serious consequences for the patient and hospitalization times. We present the case of a 33-year-old male patient with no chronic degenerative history, who started symptoms 7 months prior to admission, with intermittent fever, fatigue, asthenia, anorexia and weight loss, on physical examination he presented pain at the medium and deep palpation in the right hypochondrium, in the laboratory panel I present striking neutrophilia, in the tomography of the thorax and abdomen a cavernous lesion in the lung and complicated hepatic cysts are shown, to which percutaneous drainage guided by ultrasound is performed, with sending of cultured samples with a positive result for Streptococcus viridans. Thus, allowing treatment to be provided to the patient, thereby achieving remission of the disease.

Case analysis of brain abscesses caused by Nocardia asiatica: A case report / 中国热带医学

@#Abstract: Objective　To investigate the clinical characteristics and diagnosis key points of brain abscess caused by Nocardia asiatica, and provide a clinical basis for diagnosing and treating intracranial infection caused by Nocardia. Methods　A case of pulmonary Nocardia asiatica complicated with brain abscess diagnosed at the Second Affiliated Hospital of Hainan Medical University was selected to analyze the clinical manifestations, cerebrospinal fluid characteristics, pulmonary and cranial imaging features, and treatment plan, and to summarize the diagnosis and treatment experience. Results　The patient was an elderly woman with a history of diabetes, dry cough was the first symptom without fever or headache. At the beginning of the course, it was diagnosed as pulmonary infection and tuberculosis in the local hospital, and received conventional antimicrobial and anti-tuberculosis therapies, but showed no improvement. The patient developed progressive limb weakness, followed by consciousness disorders, and coma. Cerebrospinal fluid (CSF) adenosine deaminase and lactate dehydrogenase were not abnormal, CSF pressure, protein and white blood cells were high, mainly with multiple nuclear cells. CSF glucose and chloride were normal in the early stage of the disease, but decreased significantly in the later stage. Metagenomic analysis of cerebrospinal fluid indicated Nocardia asiatica with a specific sequence number of 537. Lung CT showed exudation, abscess, and cavity in the right lung. Skull MRI scan + enhancement suggested multiple scattered abscesses in both cerebral hemispheres. The abscesses were of different sizes and showed ring enhancement, with extensive surrounding edema, and ventricular compression. After treatment with meropenem, linezolid, and compound sulfamethoxazole tablets, the cerebrospinal fluid recovered, and the lesions in the lungs and intracranial structures improved. Conclusions　Brain abscess caused by Nocardia asiatica is similar to the tuberculous brain in clinical symptoms, cerebrospinal fluid examination, craniocerebral imaging, so we should be alert to the possibility of Nocardia infection in patients with diabetes. At the same time, metagenomic testing of the cerebrospinal fluid can help confirm the diagnosis. The mortality and disability rates of brain abscess caused by Nocardia are high. Early diagnosis and treatment can improve the prognosis.

An Unusual Cause of Lung Abscess

A 75-year-old male, with multiple co-morbidities including chronic obstructive pulmonary disease, type II diabetes mellitus and bronchogenic carcinoma, presented with lung abscess, and was detected to have Salmonella entericaserovar Anatum, non-typhoid Salmonella (NTS) infection. Treatment with appropriate antibiotics and source control by image-guided drainage showed rapid clinical improvement. To the best of our knowledge, this is the first case report of lung abscess caused by Salmonella enterica species serovar Anatum.

Absceso pulmonar con fístula neumocutánea / Pulmonary abscess with pneumocutaneous fistula

Lung abscess is a rare entity in pediatric age, but it generates significant morbidity. Even less frequent is the presence of this with spontaneous drainage to the skin, generating an abscess in the chest wall, reason for consultation, of the present clinical case. Subsequently, the presence of lung abscess with extension to the chest wall without pleural involvement was documented by imaging studies, an extremely rare and unusual entity, with only one case described in the world literature within our reach and in an adult patient.

El absceso pulmonar es una entidad infrecuente en la edad pediátrica, pero que genera una morbilidad importante. Aún menos frecuente es la presencia de este con drenaje espontáneo a piel, generando un absceso en pared torácica, motivo de consulta, del presente caso clínico. Posteriormente y por estudios imagenológicos se documentó la presencia de absceso pulmonar con extensión a pared torácica sin afectación pleural, una entidad extremadamente rara e inusual, con un solo caso descrito en la literatura mundial a nuestro alcance y en un paciente adulto.

Pulmonary artery aneurysm rupture

Pulmonary artery aneurysm is a disorder of varying etiology and should be diagnosed early for appropriate interventions. A 45-year-old man was hospitalized for chest pain, dyspnea, cough, chills, diarrhea, and vomiting, which had started 3 weeks before admission. Physical examination indicated a reduced vesicular murmur in the right hemithorax. A chest x-ray performed indicated a pneumothorax and pulmonary abscess in the right hemithorax. Thoracostomy released abundant purulent and fetid fluid. Direct examination of the pleural fluid using saline revealed structures similar to Trichomonas. Non-contrast chest computed tomography revealed right pneumothorax along with an irregular cavitation located at the pleuropulmonary interface of the posterior margin of the right lower lobe. A pleurostomy was performed. On the second postoperative day, the patient suffered a sudden major hemorrhage through the surgical wound and died on the way to the operating room. The autopsy revealed an abscess and ruptured aneurysm of the lower lobar artery in the lower right lung. Microscopic examination revealed extensive liquefactive necrosis associated with purulent inflammation and the presence of filamentous fungi and spores. This case can be characterized as a severe disorder that requires early diagnosis to achieve a good therapeutic response and to avoid fatal outcomes.

Retrospective Study of Surgical Treatment of Thoracic Empyema in Adults

Background: Pleural space infection is common and causessignificant morbidity and mortality up to 10%. The propermanagement of empyema remains controversial, and patientsare often seen by a physician after their purulent process hasalready reached the fibrinopurulent or chronic stage. Thesepatients are often subjected to multiple procedures and longhospitalization before the empyema is successfully treated.Most cases are treated initially using antibiotics with or withoutrepeated thoracentesis or chest tube insertion. Surgicalapproaches, such as video-assisted thoracic surgery (VATS) oropen thoracotomy and decortications, are usually reserved forpatients with deteriorated clinical condition following failedconservative treatment, which in turn increase the mortalityrate.Aims and Objective: The aim of our retrospective study is toevaluate our experience with thoracic empyema over a 36-month period with special attention to procedures used,success rate of each procedure and outcome.Materials & Methods: A retrospective chart analysis onpatients in whom thoracic empyema was diagnosed fromMarch 2016 to March 2018 at Civil hospital, BJ Medicalcollege, Ahmedabad, India. was performed. The definition ofempyema was selected as any pleural fluid that was grosslypurulent, and/or had a positive Gram stain or culture andempyema were classified by etiology and culture results.Charts were reviewed for patients age, symptoms, underlyingdisease, etiology of empyema, culture results, diagnosticmodalities, duration of hospitalization, therapeutic intervention,date of procedures, complications, mortality and long-termoutcome.Results and Conclusion: Empyema thoracis is a cause ofhigh mortality in man and its occurrence is increasing in bothchildren and adults. Two guidelines documents on themanagement of empyema in adults have been published bythe ACCP and the BTS. Although they differ in their approachto management, they agree on that the pleural space shouldbe drained in all patients with exudative PPE with pleural fluidpH < 7.2 and in those who have frank pus in the pleural space.Patients who do not improve should be referred to the surgeonfor further management. A large randomized multi-centre trialhas shown no survival advantage with the use of intrapleuralstreptokinase in patients with pleural infection and the use ofstreptokinase has not prevented surgery in the group ofpatients studied. However, streptokinase enhances infectedpleural fluid drainage and may still be used in patients whohave large collection of infected pleural collection causingventilatory impairment.

The first central nervous system autopsy in Southern Brazil / Primeira autópsia do sistema nervoso central no sul do Brasil

ABSTRACT Objective: The history of Anatomical Pathology in the state of Paraná, in southern Brazil, is closely linked with the foundation of the Universidade Federal do Paraná (UFPR). This study identified the first central nervous system (CNS) clinical autopsy performed by the Department of Anatomical Pathology of the UFPR. Methods: This study reviewed the autopsy report archives of the Hospital de Clínicas-UFPR from 1951 onward. The clinical anatomy interpretations of the autopsy report and possible etiologic agents were discussed. Result: The first adult clinical autopsy with CNS study was performed on April 23, 1952 on a 45-year-old man with lobar pneumonia with abscesses complicated by bacterial meningitis. Conclusion: This case was the first CNS clinical autopsy performed in the state of Paraná and, possibly, in southern Brazil. The death was due to an infectious disease, which was the main cause of death in Brazil in the 1950s.

RESUMO Objetivo: A história da Anatomia Patológica no Estado do Paraná, sul do Brasil, está ligada com a fundação da Universidade Federal do Paraná (UFPR). Este estudo identificou a primeira autópsia clínica do sistema nervoso central (SNC) realizada pelo Departamento de Anatomia Patológica da UFPR. Métodos: Foi realizada revisão dos arquivos dos relatórios de autópsia do HC-UFPR, desde 1951. As interpretações anátomo-clínicas do laudo da autópsia e os possíveis agentes etiológicos foram discutidas. Resultado: A primeira autópsia clínica em adulto com estudo do SNC foi realizada em 23 de abril de 1952. Um homem de 45 anos com pneumonia lobar com abscessos pulmonares, complicada com meningite bacteriana. Conclusão: Este caso é a primeira autópsia clínica em adulto com estudo do SNC do estado do Paraná e possivelmente do Sul do Brasil. A causa da morte foi devido a uma doença infecciosa, as principais causas de óbito no Brasil nos anos 50.

A case report of neonatal-onset chronic granulomatosis disease with aspergillus infection and literature review / 中国新生儿科杂志

Objective To study the clinical features,diagnosis,treatment and genetic characteristics of chronic granulomatosis disease (CGD) in neonates,and to improve the understanding of CGD.Method Clinical manifestations and treatments of one patient with CGD and aspergillus infection in our hospital were analyzed.Key words including "infant","newborn","chronic granulomatous disease","lung abscess",and "aspergillus infection"were searched in Chinese medical databases,PubMed and Embase until 2018 September.The clinical features and genetic mutations of CGD reported in literature were summarized.Result The patient in our hospital was a full-term male infant naturally delivered with birth weight of 3 400 g.The onset of the disease was on the 19th day after birth,and the initial clinical manifestations included fever,cough,and then pulmonary abscess,diarrhea,recurrent skin infection,and aspergillus infection.Anti-infection and symptom-alleviating treatments were not effective,and weight gain was poor.Laboratory examination indicated bacterial and fungal infection.The neutrophil respiratory burst test was positive and indicated CGD.Hetero-zygotic frameshift mutation [c.1599-1602delAGTTt (p.V534Sfs* 12)] of CYBB gene 13 exon was detected and the diagnosis of CGD was confirmed.The mother carried the heterozygous mutation and the father didn't.Antifungal therapy was continued after the children got better and discharged from hospital.The patient was followed up until 3-month-old and his condition was stable.Our literature review revealed 28 reports including 108 cases of CGD infants,including 79 male cases (73.1％) and 21 female cases (19.4％).Most of the CGD infants (79/108,73.1％) had the onset within 2 weeks of life.The main clinical features included pneumonia/pulmonary abscess/pleural effusion (87.0％),diarrhea (58.3％),perianal abscess (35.2％),skin infection (53.7％),aspergillus infection (41.7％),and tuberculosis infection (26.9％).75 cases had positive neutrophil respiratory burst test (69.4％),and 95 cases were diagnosed using genetic tests (88.0％).Over 300 loci of the CYBB gene mutation had been reported contributing to the disease.28 cases had abnormal family history (25.9％),19 cases received hematopoietic stem cell transplantation (17.6％),41 cases had clinical improvement (38.0％),and 35 cases died (32.4％).Conclusion CGD is rare in neonatal period.The main clinical manifestations included recurrent infection with pathogens like aspergillus,tuberculosis and others.CGD can be diagnosed based on recurrent multiple bacterial or fungal infections,neutrophil respiratory burst test and gene tests.CGD should be considered among children with recurrent infections at early life stage,especially those with poor maternal history or positive family history.

Mielopatía aguda compresiva por absceso pulmonar. Presentación de un caso / Compressive acute myelopathy by pulmonary abscess. A case report

Las mielopatías constituyen un conjunto heterogéneo de procesos patológicos que directa o indirectamente afectan a la médula espinal. Son poco frecuentes y pueden ser producidos por variadas causas y vías de afectación, que conllevan a grandes secuelas y elevada discapacidad. Se describe un caso de mielopatía aguda compresiva desencadenada por un absceso pulmonar como causa y mecanismo de producción inusual. Hombre de 48 años, con antecedentes de salud y cuadro clínico de inicio brusco de paraparesia fláccida e hiporreflexia osteotendinosa de miembros inferiores asimétrica, con predominio derecho, nivel sensitivo dorsal a nivel de D4 y dolor a la percusión en procesos espinosos dorsales en D3-D6. Los estudios sanguíneos, inmunológicos y de líquido cefalorraquídeo resultaron irrelevantes, excepto muestra de signos indirectos de infección. La radiografía de tórax mostró la presencia del absceso pulmonar primario derecho y la afectación medular se corroboró a través de la realización de la resonancia magnética medular dorsal. Presentó pobre respuesta ante los esteroides parenteral, hasta que se inició la terapia antibiótica, de forma paulatina y con apoyo rehabilitador. Transcurridos tres meses se investigaron y fueron descartadas otras etiologías no compresivas. Las mielopatías agudas representan un grupo heterogéneo de trastornos con distintas etiologías y mecanismos de producción, a través de su estudio se evidenció como causa un absceso pulmonar con afectación medular, por lo que debe ser considerado en la extensa lista de diagnósticos diferenciales (AU).

Myelopathies are a heterogeneous group of pathological processes that directly or indirectly affect the spinal cord. They are rare and can be produced by different causes and affectation pathways leading to major consequences and high disability. A case of acute compressive myelopathy triggered by a lung abscess as unusual cause and production mechanism is described. It is the case of a man, aged 48 years, with a clinical history and symptoms of acute onset of flaccid paraparesis and asymmetric osteotendinous hyporeflexia of lower limbs, with right predominance, dorsal sensitive level at D4, and pain at percussion in D3-D6 dorsal spinal processes. Blood, immune and cerebrospinal fluid (CSF) studies were irrelevant, but showing indirect signs of infection. Chest radiography showed the presence of the right primary lung abscess and spinal cord involvement was confirmed by performing dorsal medullar magnetic resonance (MRI). The patient had poor response to parenteral steroids until antibiotic therapy began, gradually and with rehabilitation support. After three months, other non-comprehensive etiologies were studied and ruled out. Acute myelopathies represent a heterogeneous group of disorders with different etiologies and production mechanisms. The study evidenced a lung abscess with spinal cord involvement as a cause, so it should be considered in the extensive list of differential diagnoses (AU).

A Case of Tricuspid Valve Endocarditis Complicated with Severe Lung Abscess / 日本心臓血管外科学会雑誌

<p>A 25-year-old woman with a history of atopic dermatitis was admitted to hospital with shortness of breath, high fever, cough, and bloody sputum. Chest X-ray showed a diffuse infiltrative shadow. We diagnosed pneumonia, and antibacterial therapy was started ; however, the treatment was ineffective. Echocardiography showed tricuspid endocarditis, and she was thus transferred to our hospital. We selected medical treatment because the case was complicated with severe lung abscesses and pulmonary failure. As a result of appropriate antibacterial medication for 4 weeks, her symptoms and lung abscesses were improved ; however, tricuspid regurgitation and right heart failure continued to worsen. Therefore, the patient underwent vegetectomy and tricuspid valve plasty. No perioperative pulmonary complication was observed. She continued to receive the same antibacterial treatment after 2 weeks. In preceding antibacterial treatment before surgical treatment, it is effective for tricuspid endocarditis complicated with severe lung abscess.</p>

Prostatic abscess of Klebsiella pneumonia complicating septic pulmonary emboli and meningitis: A case report and brief review

Prostatic abscess is a rare entity with an incidence of 0.5%-2.5% in all prostate diseases and usually occurs in the 5th and 6th decades of life with immunocompromised status. Prostatic abscess might be a process of evolution from acute prostatitis. Klebsiella pneumoniae is the leading microorganism in the diabetic patients of prostatic abscess in Taiwan. A 60-year-old diabetic man, with a one-week history of acute bacterial prostatitis was reported in this study, presenting to the emergency department with sudden altered mental status. The abdominal computed tomographic scan demonstrated lobulated prostatic abscess and multiple septic pulmonary emboli with lung abscesses. Analysis of cerebrospinal fluid showed white blood cells of 10771 counts/mm with segmented neutrophils of 99%. Cultures of blood, cerebrospinal fluid and sputum yielded Klebsiella pneumoniae. We concluded that computed tomographic scan can make a definite diagnosis of prostatic abscess associated with complications and management with empiric antibiotics and adequate drainage is suggested.

Prostatic abscess of Klebsiella pneumonia complicating septic pulmonary emboli and meningitis: A case report and brief review

Prostatic abscess is a rare entity with an incidence of 0.5%–2.5% in all prostate diseases and usually occurs in the 5th and 6th decades of life with immunocompromised status. Prostatic abscess might be a process of evolution from acute prostatitis. Klebsiella pneumoniae is the leading microorganism in the diabetic patients of prostatic abscess in Taiwan. A 60-year-old diabetic man, with a one-week history of acute bacterial prostatitis was reported in this study, presenting to the emergency department with sudden altered mental status. The abdominal computed tomographic scan demonstrated lobulated prostatic abscess and multiple septic pulmonary emboli with lung abscesses. Analysis of cerebrospinal fluid showed white blood cells of 10 771 counts/mm

Determination of the Initial Time of Peripheral Pulmonary Lesion by Real-time Contrast-enhanced Ultrasound / 中国医学影像学杂志

Purpose To evaluate the value of real-time contrast-enhanced ultrasound (CEUS) combined with comparative observation in determining the initial time of peripheral lung lesion,and to provide a new method for the diagnosis of peripheral lung disease by CEUS.Materials and Methods Sixty patients with peripheral lung disease diagnosed by chest X-ray or CT examination were examined by CEUS,and the lesions and perfusion of surrounding lung tissue were observed in real time and comparatively.The time of initial enhancement of peripheral lung lesion was determined by real-time comparative observation method,that is,to compare the time of contrast agent to reach the peripheral lung lesion with the time to reach the adjacent gas-containing lung tissue.All lesion specimens were obtained by surgery or ultrasound-guided percutaneous biopsy,and the pathological diagnosis was performed.According to the pathological results,the peripheral lung lesions were classified into the malignant group,the chronic inflammation group and the pneumonia group.Results Sixty cases of peripheral lung lesions were identified as 38 cases of malignant tumors (including 15 cases ofsquamous cell carcinomas,9 cases of adenocarcinoma cell carcinomas,2 cases of large cell carcinomas,9 cases of small cell carcinomas and 3 cases of metastatic carcinomas),14 cases of chronic inflammation lesions (including 7 cases of tuberculomas,3 cases of inflammatory pseudotumors and 4 cases of lung abscess) and 8 cases of pneumonia.The detection rates of pulmonary arterial phase and bronchial artery phase using the real-time comparative observation method were 100％ (60/60) and 85％ (51/60),respectively.The initial time of pulmonary arterial phase and bronchial artery phase were (6.1 ± 0.9) s and (10.5 ± 1.6) s,respectively.The initial time of pulmonary arterial phase was sooner than bronchial artery phase,the difference was statistical significance (P＜0.05).Conclusion The real-time CEUS combined with comparative observation method has important diagnostic value in judging the initial enhancement time of peripheral lung lesion and can provide a new method for the accurate diagnosis of peripheral lung disease,which is worth popularizing.

Hepatobronchial Fistula and Lung Abscess after Transarterial Chemoembolization / 대한소화기학회지

Transarterial chemoembolization (TACE) is a common treatment modality to locally manage hepatocellular carcinoma. Liver abscess and bile duct injury are common complications of TACE. However, hepatobronchial fistula is a rare complication. Herein, we report a case of lung abscess due to hepatobronchial fistula after TACE. A 67-year-old man, who had underwent TACE 6 months ago, presented cough and bile-colored sputum. He was diagnosed with lung abscess and hepatobronchial fistula. We performed endoscopic retrograde cholangiopancreatography; however, there was no improvement in his symptoms. Thereafter, partial hepatectomy and repair of fistula were successively conducted.

Neumonías necrosantes graves con empiema asociado / Severe necrotizing pneumonias with secondary empyemas

Introducción: Las neumonías necrosantes (NN) con empiema son una enfermedad grave y un desafío multidisciplinario. El objetivo de este estudio es realizar una caracterización epidemiológica y, en forma secundaria, analizar su tratamiento y evolución. Presentación de casos: Se realizó un estudio retrospectivo de una serie de casos consecutivos con NN con empiema que se presentaron en el Hospital Padre Hurtado. Siete (77,8%) eran de sexo masculino. La mediana de edad fue de 53 (rango 21-73) años. El 44% presentaban comorbilidades (diabetes, HTA o enfermedades neurológicas). El 44% presentaban abuso de drogas y 3 estaban en un estado de desnutrición severa. Manejo y evolución: La mediana de tiempo de hospitalización fue de 41 (rango 16-129) días. En 4 pacientes el germen aislado fue un Enterococcus faecalis. Complicaciones torácicas ocurrieron en el 33,3% de los pacientes. Un paciente requirió una lobectomía, un paciente una fenestración y otro paciente falleció. Discusión: Las NN con empiemas son raras. Sin embargo, frente a la asociación de diabetes, desnutrición y abuso de drogas continuaremos viendo estos casos de difícil manejo con elevada morbimortalidad.

Introduction: Necrotizing pneumonia complicated with empyema is a life-threatening condition that challenges multidisciplinary teams. The aim of this study is to perform an epidemiological characterization of these patients, and secondly, analyse their treatment and outcomes. Case presentation: A retrospective analysis of a series of consecutive patients experiencing necrotizing pneumonia with empyema who presented at Hospital Padre Hurtado. Seven (77.8%) were male. The median age was 53 (range 21-73) years. 44% presented with comorbidities (diabetes, high blood pressure, and neurological diseases). 44% presented drug abuse consumption and three (33.3%) were in a state of severe malnutrition. Management and outcome: The median time of hospitalization was 41 (range 16-129) days. Thoracotomies were performed in eight (83.2%) of the patients. In four patients, the isolated bacteria's were Enterococcus faecalis. Thoracic complications occurred in three (33.3%) patients. One patient required a lobectomy, one patient a fenestration and one (11.1%) patient died. Discussion: Necrotizing pneumonias complicated with empyema are rare, however, if there is an association with drug abuse, diabetes and malnutrition, we will continue to see such challenging cases with high morbidity and mortality.

Combined use of a double-lumen tube and Fogarty catheter to prevent the endobronchial spread of infection: a case report / 대한마취과학회지

Huntington's disease is a neurodegenerative disorder with an autosomal dominant inheritance pattern. Patients with Huntington's disease show an increased risk of aspiration pneumonia when the pharyngeal muscle is invaded. We report a case of advanced-stage Huntington's disease in which the patient received right middle lobectomy for a lung abscess caused by repeated aspiration. The best lung isolation technique has not yet been established in these patients. We successfully performed selective lobar isolation of the right lower and middle lobes using a double lumen tube and a Fogarty embolectomy catheter.

Diagnostic Dilemma in a 70-Year-Old Man with Fever and Air-fluid Level on Chest X-ray.

Infected bullae are frequently confused with a pulmonary abscess. There recognition is important to avoid unnecessary interventions. We describe a case of 70 years male patient, who came with complaints of breathlessness since 5 years, cough with a moderate amount of mucopurulent expectoration, pain in back and right shoulder and low-grade intermittent fever all since 20 days. Past history was unremarkable. There is a history of 100 pack-years. On examination, he was tachypneic, having oxygen saturation of 87% on room air. On respiratory examination; the finding was consistent with emphysema with right sided cavitary disease. Chest X-ray showed thin walled cavity with fluid level in the right upper zone with pneumothorax on the left side. Investigations revealed 17, 000 white blood cell with neutrophil predominance. He was not responding adequately so high-resolution computed tomography (HRCT) was ordered which showed multiple thin-walled bullae in both lung along with air-fluid level in one large bullae with surrounding pneumonitis on the right side. Infected emphysematous bullae should be suspected when a fluid level appears in a patient with clinical finding suggestive of emphysema. We propose that symptomatic patients with radiological signs of air-fluid level should be evaluated with HRCT to rule out similar condition and assessment of underlying condition.

Enfermedad periodontal inflamatoria asociada a un absceso pulmonar. Presentación de un caso / Peridental inflammatory Disease associated to lung abscess. Case presentation / Peridental inflammatory Disease associated to lung abscess. Case presentation

Fundamento: A pesar, de que hay reportes de casos en la literatura internacional, que asocian la enfermedad periodontal con enfermedades respiratorias y medidas para la prevención de la enfermedad periodontal inflamatoria, sino se establece un adecuado manejo de esta última, puede evolucionar con una complicación sistémica como es el absceso pulmonar. Objetivo: Ilustrar cómo la enfermedad periodontal inflamatoria puede asociarse a un absceso pulmonar como complicación sistémica en su evolución. Presentación del caso: Se presenta una paciente femenina con antecedentes de absceso periodontal y enfermedad periodontal crónica, los cuales constituyeron las únicas causas demostradas del desarrollo de un absceso pulmonar, tras la aplicación del método clínico. Conclusiones: La enfermedad periodontal inflamatoria puede evolucionar hacia la remisión si se adoptan las medidas protocolizadas para su tratamiento, sin embargo, siempre que esa enfermedad siga su curso natural o no se maneje adecuadamente puede evolucionar a complicaciones sistémicas como lo es el absceso pulmonar.

Background: Although there are in the international literature report of cases, which associate the peridental disease to respiratory diseases and measurements to the prevention of the peridental inflammatory disease, if there is not established an adequate usage of the last one, it can emerge with a systemic complication like lung abscess. Objective: To show how the peridental inflammatory disease can be associated to a lung abscess like a systemic complication in its evolution Case Presentation: A female patience is presented with antecedents of peridental abscess and chronic peridental disease, which were the unique causes demonstrated in the development of a lung abscess, after the application of the clinic method Conclusions: The peridental inflammatory disease can emerge towards the remission if some protocolic precautions are adopted for its treatment; nevertheless whenever the disease follows its natural course or it is not properly managed it can emerge to systemic complications like, it is the lung abscess.