Salahuddin Naseem, Baig-Ansari Naila, Fatimi Saulat Hasnain
Department of Medicine, The Aga Khan University Hospital, Department of Infectious Diseases, The Indus Hospital, Karachi.
Department of Epidemiology, The Indus Hospital Research Center, Karachi.
J Pak Med Assoc. 2016 Jun;66(6):754-6.
To our knowledge, this is an unusual case of a community-acquired pneumonia (CAP) with sepsis secondary to Streptococcus pneumoniae that required lung resection for a non-resolving consolidation. A 74 year old previously healthy woman, presented with acute fever, chills and pleuritic chest pain in Emergency Department (ED). A diagnosis of CAP was established with a Pneumonia Severity Index CURB-65 score of 5/5. In the ER, she was promptly and appropriately managed with antibiotics and aggressive supportive therapy. She remained on ten days of intravenous antibiotics. However, 48 hours post antibiotic course, she returned to ER with fever and signs of sepsis. Despite timely and appropriate management, the consolidated lobe remained the focus of sepsis for over four weeks. The patient recovered after the offending lobe was resected. Histopathology of the lung tissue revealed acute and chronic inflammation. However, no malignancy, bacterial infection or broncho-pleural fistula was found. Eighteen months post-surgery, the patient remains well.
据我们所知，这是一例不寻常的社区获得性肺炎（CAP）病例，由肺炎链球菌引起败血症，因肺部实变不消散而需要进行肺切除。一名74岁、既往健康的女性，在急诊科出现急性发热、寒战和胸膜炎性胸痛。根据肺炎严重程度指数CURB-65评分为5/5，确诊为CAP。在急诊室，她接受了及时且恰当的抗生素治疗和积极的支持治疗。她接受了为期十天的静脉抗生素治疗。然而，抗生素疗程结束48小时后，她因发热和败血症迹象再次返回急诊室。尽管进行了及时且恰当的治疗，但实变肺叶在四周多的时间里一直是败血症的病灶。切除病变肺叶后，患者康复。肺组织的组织病理学检查显示有急性和慢性炎症。然而，未发现恶性肿瘤、细菌感染或支气管胸膜瘘。术后18个月，患者情况良好。
