A46 INFECTIONS AND INFECTIOUS COMPLICATIONS IN THE ICU / Thematic Poster Session / Sunday, May 15/09:30 AM-03:45

PM / Area K, Hall F (North Building, Exhibition Level), Moscone Center

A Rare Case of Necrotizing Pneumonia Complicated with Pneumothorax

M. Al Khateeb1, M. Aldiabat2, Y. Al Jabiri1; 1Internal Medicine, NYCHHC Lincoln medical center,

Bronx, NY, United States, 2Internal Medicine, Lincoln Medical Center, Bronx, NY, United States.

Corresponding author's email: mohanadkhat@outlook.com

Introduction: Necrotizing pneumonia is an uncommon severe complication characterized by

inflammation, consolidation progressive peripheral necrosis of lung parenchyma, multiple small
cavities secondary to cytokines and toxins release; furthermore, it can cause vascular interruption
secondary to thrombus formation which favors uncontrolled bacterial growth, impaired antibiotic
delivery resulting in liquefaction and gangrene formation. Case Presentation: 45-year-old male was
found lying down with bizarre behavior. On presentation he was disheveled with poor hygiene and
food inside his mouth. Later, his clinical status deteriorated with tachypnea, tachycardia and
accessory muscle use, intubated due to hypoxemic respiratory failure. Chest radiograph on
admission showed right lower lobe infiltrate. He was started on ceftriaxone and azithromycin as an
empirical treatment, after obtaining blood and tracheal aspirate cultures. On the second day after
intubation, his hospital course was complicated with septic shock with drop in blood pressure, right
subclavian central line was placed to start vasopressors medications. Chest radiograph obtained
after insertion of central line confirmed central line placement without complications, also shows
worsening of the infiltrate in the right lower lobe of the lung. On the 4th day, he spiked fever, with
drop in blood pressure requiring increase in the vasopressors with full ventilatory support. chest
radiograph showed new right sided pneumothorax portable chest x ray shows right lower lobe
infiltrates with pneumothorax on the right side. On that day, antibiotic therapy escalated to
piperacillin tazobactam therapy. CT scan was done after placement of chest tube as in the attached
figure. Culture from tracheal aspiration came back positive for numerous Klebsiella pneumoniae.
Discussion: we describe a case of necrotizing pneumonia complicated with pneumothorax. The
consolidation with surrounding inflammation progressed to cavities and pleural abnormalities and
eventually pneumothorax. Iatrogenic pneumothorax from right subclavian central line placement
would be one of the causes of pneumothorax in this case, but it was ruled out with chest radiograph
confirmed placement 2 days prior to pneumothorax complication event and serial physical
examinations prior to the event of pneumothorax with confirmed bilateral air entry with crackles
bilaterally. Our case requires special attention to this rare but serious presentation, which can lead
to death if not appropriately evaluated with the pertinent treatments and interventions when needed.
To the best of our knowledge, necrotizing pneumonia has been described before as a rare
complication of pneumonia, but never described in similar presentation and complication.
This abstract is funded by: none

Am J Respir Crit Care Med 2022;205:A1623

Internet address: www.atsjournals.org Online Abstracts Issue