Severe S. pneumoniae bronchopneumonia | Figure 1

Severe S. pneumoniae bronchopneumonia

58-y.o. male, smoker, with no medical history presented on ED for progressing dyspnoea, productive cough and weakness. Initial BP: 141/96mmHg, HR: 113/min., T: 36.5 °C, SatO2: 96% / 6l O2 mask. Cold sticky sweat on the skin. X-ray showed serious inflammatory changes bilaterally. Initial CT-chest scan showed extensive consolidations with compressed to closed lobar and segmental bronchi. We administered ATB (Cefotaxime + Moxifloxacin) empirically. In blood culture, tonsils and urine (Ag) was detected S. pneumoniae sensitive to administered ATB. Despite that, on the 7th day of hospitalization, there were sudden worsening with serious respiratory failure and hypotension. X-ray and CT scans showed massive PTX, subcutaneous emphysema. Chest drainages were introduced.

Diagnosis

Severe S. pneumoniae bronchopneumonia

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