Severe acute necrotising Community Acquired Pneumonia with Pyopneumothorax due to Pseudomonas aeruginosa in a healthy young girl

Abstract

Aim: We report this case to acknowledge the presence of multi drug resistant Pseudomonas aeruginosa in the community setting, which transpired in a young female, without any known comorbidity or exposure risk.

Background: Pseudomonas aeruginosa is an extremely unusual pathogen in community acquired pneumonia (CAP), especially in previously healthy young adults. Immune status, underlying lung disease and possible exposures like hot tub use, should always be ruled out. There have been reports of bacterial aetiology being next common after Tuberculosis for Pyopneumothorax, but ours is the first case to report P.aeruginosa as a cause of CAP and pyopneumothorax in an absolutely healthy young adult.

Case description: A young female, developed Pneumonia from the community setting which grew a nosocomial organism. Complications involved cavity formation and Pyopneumothorax, which required Intercostal Drainage (ICD) and extensive intravenous antibiotics. Immediate and appropriate management is life saving.

Conclusion: CAP due to heinous organisms like Pseudomonas aeruginosa should be suspected in any patient who presents with a rapidly progressive course, even in the absence of risk factors and exposures. In cases of Pleural effusion or Pneumothorax or both, ICD drain should be inserted. Broad spectrum antibiotic coverage especially in hemodynamically unstable patients should be initiated immediately, followed by antibiotic stewardship protocols.

Clinical significance: We would like to emphasize the importance of acquiring cultures from respiratory site, for early initiation/switching of appropriate antibiotics. Also Pseudomonas being an ominous organism yields a finer prognosis only when treated with appropriate anti-pseudomonal antibiotics.