CASE REPORT   

Minerva Respiratory Medicine 2021 December;60(4):146-9

DOI: 10.23736/S2784-8477.21.01917-9

Copyright © 2021 EDIZIONI MINERVA MEDICA

language: English

Necrotizing pneumonia: an incipient problem in children, report of two cases

Olga KASTRITSI ¹, Stelios SAKELLARIS ¹, Georgia PETRA ³, Ioannis DROSITIS ², Emmanouela MAVRIDI ¹, George SAKELLARIS ¹ ✉

¹ Department of Pediatric Surgery, University General Hospital of Heraklion, Crete, Greece; ² Department of Cardiothoracic Surgery, University General Hospital of Heraklion, Crete, Greece; ³ Department of General Surgery, University General Hospital of Heraklion, Crete, Greece

Necrotizing pneumonia is a severe and uncommon complication of pneumonia and is characterized by progressive pneumonic illness in a previously healthy child, despite appropriate antibiotic therapy. A 3.5-year-old female toddler was admitted to our hospital due to deteriorating pneumonia with a pleural effusion, which began 15 days prior, and the second case is about a 4-year-old male patient, being feverish, coughing, with ailment, dyspnea and grunt. A CT scan performed on the first case indicated a pleural effusion and multiple consolidations. The pleural fluid was drained via a chest tube and Gram stain revealed a Gram-positive coccus. Streptococcus pneumoniae was identified. Additional CT findings indicated a large hydropneumothorax on the right side, as well as a cavity, possibly a ruptured abscess. Wedge resection of the cavity and drainage of the hemithorax was performed. Regarding the second patient, the laboratory tests were indicative of an inflammatory syndrome, while a chest X-ray reflected consolidations in the middle right lobe, the lower left lobe, and the presence of pleural effusion. Acinetobacter baumannii was identified in the Bronchoalveolar lavage. A left lower lobectomy and right-sided pulmonary necrosectomy were performed. Necrotizing pneumonia is an incipient problem in children. The diagnosis of necrotizing pneumonia should be considered for a child with pneumonia who remains unwell after 72 hours, even though antibiotics have been administered.

KEY WORDS: Necrotizing pneumonia; Child; Community-acquired infections; Pneumococcal pneumonia; Acinetobacter baumannii