title: Unusual case of non-resolving necrotizing pneumonia: A last resort measure for cure.
abstract: 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.
authors.affiliation: Department of Medicine, The Aga Khan University Hospital, Department of Infectious Diseases, The Indus Hospital, Karachi.
authors.forename: Naseem
authors.initials: N
authors.lastname: Salahuddin
authors.affiliation: Department of Epidemiology, The Indus Hospital Research Center, Karachi.
authors.forename: Naila
authors.initials: N
authors.lastname: Baig-Ansari
authors.affiliation: Section of Cardiothoracic Surgery, Department of Surgery, The Aga Khan University Hospital, Karachi, Pakistan.
authors.forename: Saulat Hasnain
authors.initials: SH
authors.lastname: Fatimi
mesh_terms: D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D017714:Community-Acquired Infections; D005260:Female; D006801:Humans; D008168:Lung; D011014:Pneumonia; D000071067:Pneumonia, Necrotizing / Q000188:drug therapy / Q000601:surgery*; D011018:Pneumonia, Pneumococcal / Q000188:drug therapy / Q000601:surgery*; D013296:Streptococcus pneumoniae
chemical_list: D000900:Anti-Bacterial Agents
keywords: Necrotizing pneumonia, Nonresolving pneumonia, Community-acquired pneumonia, Strep pneumoniae, Lung resection.