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Our interesting case
We regularly do case studies. Here is a 55 years old male patient has a complaint of right-sided pleuritic chest pain. For this, he was admitted to one of the hospitals of Amreli a city in Gujarat.
The patient was investigated. X-ray and sonography investigation detected a right lower lobe consolidated with pleural effusion.
Pleural fluid aspirated and sent for further evaluation. But exudative with culture report showing no growth for any infective organism.
As a treatment part, he received intravenous cefepime and tazobactam combination antibiotics for three days. He was improved with the treatment. Therefore he was discharged on oral faropenem antibiotics.
The patient was stable for one week and again he suffered from pleuritic pain with fever.
So he was transferred to IDCC hospital which is located in Surat city of Gujarat under the care of Dr. Pratik Savaj who is an infectious disease specialist.
Here patient was investigated with a CT scan of the chest and it showed necrotizing pneumonia with underlying moderate effusion.
For treatment and further investigation purposes, USG guided pigtail catheter was inserted and 300 ml of fluid was drained. The fluid was sent for evaluation. But this investigation showed exudative with no growth. Again second time no causative organism found.
When there is necrotizing pneumonia with underline effusion with 2 times negative culture report, it is suggestive of anaerobic infection. Most of the time culture samples are sent in aerobic culture bottles, that’s why culture can came negative for any organisms.
He was started with intravenous meropenem and gradually patient started improving.
To find out the source of infection, a detailed history was taken.
In the past history, he was having toothache for 4 months for which he was advised to undergo a tooth removal procedure because of a dental abscess. But he denied it.
We suggested him to undergo tooth extraction as a part of source control. If the tooth is not removed, then he might develop reinfection.
On a follow-up visit, he has completed three weeks of meropenem and tooth removal has been done. He is better now.
Learning point
An untreated tooth infection can lead to:
Necrotizing pneumonia,
Infective endocarditis,
Spinal abscess
So, never let your tooth infection or abscess untreated. It may cause major health problems in the future.
What is necrotizing pneumonia?
It is a rare and uncommon complication of pneumonia. In severe cases, the morbidity and mortality rate is high.
The most common cause is Streptococcus pneumoniae, Staphylococcus aureus, and Klebsiella pneumoniae. It may also be caused by other bacteria including Mycobacterium tuberculosis, viral and anaerobic infections also as seen in our care.
This interesting case was shared by Dr. Pratik Savaj for educational purposes. We thank again to him.