Khalafi Seyed A, De La Rosa Vaquez Alan, Dihowm Fatma
Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center El Paso, El Paso, USA.
Internal Medicine, Texas Tech University Health Sciences Center El Paso, El Paso, USA.
Cureus. 2023 Feb 20;15(2):e35226. doi: 10.7759/cureus.35226. eCollection 2023 Feb.
pneumonia is a rare infection commonly presenting with a cavitary lesion. We report a case of a 44-year-old Hispanic male with comorbidities who was admitted to our facility with multiple falls for two days, shortness of breath, continuous diarrhea, and urinary urgency. Lab results showed leukocytosis with neutrophil predominance, anemia, and respiratory alkalosis. The patient was also noted to have uncontrolled diabetes mellitus with an A1c of 17.6%. Prior to admission to the medical intensive care unit (MICU), the patient was administered vancomycin and cefepime. The patient was then started on fluconazole while admitted to the MICU. In addition, a chest X-ray was conducted, showing patchy airspace opacities in the right upper lobe. A chest and abdominal CT also showed multiple cavitary lesions, pulmonary nodules, and nodular liver contour. Bronchoscopy with bronchoalveolar lavage conferred trimethoprim/sulfamethoxazole-resistant without fungal or acid-fast bacilli growth and was subsequently started on ampicillin/sulbactam. Infectious disease was consulted and advised to begin ertapenem. The patient developed increased respiratory demands and was subsequently started on mechanical ventilation with vasopressors. The patient was successfully weaned off and downgraded to the telemetry floor. The patient was successfully discharged in stable condition. This case highlights a severe and uncommon complication of infection causing pneumonia with cavitary lesions.
肺炎是一种罕见的感染，通常表现为空洞性病变。我们报告一例44岁的西班牙裔男性病例，该患者有多种合并症，因两天内多次跌倒、呼吸急促、持续腹泻和尿急入住我院。实验室检查结果显示白细胞增多，以中性粒细胞为主，贫血，呼吸性碱中毒。该患者还被诊断为糖尿病控制不佳，糖化血红蛋白（A1c）为17.6%。在入住医疗重症监护病房（MICU）之前，患者接受了万古霉素和头孢吡肟治疗。患者入住MICU后开始使用氟康唑。此外，进行了胸部X光检查，显示右上叶有斑片状气腔模糊影。胸部和腹部CT还显示多个空洞性病变、肺结节和肝脏轮廓结节状。支气管镜检查及支气管肺泡灌洗显示对甲氧苄啶/磺胺甲恶唑耐药，无真菌或抗酸杆菌生长，随后开始使用氨苄西林/舒巴坦治疗。咨询了传染病科，建议开始使用厄他培南。患者呼吸需求增加，随后开始使用血管升压药进行机械通气。患者成功脱机并降级到遥测病房。患者病情稳定，成功出院。本病例突出了感染导致肺炎伴空洞性病变的一种严重且罕见的并发症。
