Lung gangrene in a mechanically ventilated woman due to streptococcus pneumoniae

ABSTRACT

A 51-year-old woman with long-standing type II diabetes, presented to the accident and emergency department with 5 day history of fever, cough, with minor greenish sputum and right pleuritic pain. Pulmonary auscultation revealed right rales. Arterial blood gas analysis [ABG] showed, pH 7.41; PaCO2 30 mmHg; PaO2 55 mmHg [while patient breathing oxygen at 3 L/minute]. Chest radiograph showed a consolidated area in the right middle lobe. The patient was admitted in the intensive care unit for further management. Because of persistent hypoxia the patient was intubated and placed on mechanical ventilator. Multiple sputum smears revealed Gram-positive cocci while sputum cultures revealed Streptococcus pneumoniae. Two blood cultures obtained on admission yielded Streptococcus pneumoniae. A CT scan of the chest revealed a crescent-shaped lucency [air crescent sign] within the area of consolidation in the right middle lobe. Based on these radiographic findings the patient was diagnosed with lung gangrene and she was treated with antibiotic. There was no time to intervene surgically because she died six days after admission