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Case Reports
. 2023 Jan 10:9:1007160.
doi: 10.3389/fmed.2022.1007160. eCollection 2022.

Case report: Streptococcus pneumoniae pneumonia characterized by diffuse centrilobular nodules in both lungs

Fangqi Zhang  1 , Shaowen Qin  1 , Fei Xia  1 , Congzheng Mao  1 , Long Li  1
Affiliations
Case Reports

Case report: Streptococcus pneumoniae pneumonia characterized by diffuse centrilobular nodules in both lungs

Fangqi Zhang et al. Front Med (Lausanne). .

Abstract

Background: Streptococcus pneumoniae (S. pneumoniae) is the most common pathogen in community-acquired pneumonia (CAP) and takes the form of lobar pneumonia as typical computed tomography (CT) findings. Various patterns of radiological manifestation have also been reported in patients with S. pneumoniae pneumonia; however, the appearance of diffuse centrilobular nodules in both lungs is rarely reported.

Case presentation: We report the case of a patient with a history of chronic lymphocytic leukemia (CLL) for 9 years who presented with new-onset fever, cough, excess sputum, and shortness of breath for 1 week. He was given intravenous antibacterial (cephalosporin) treatment for 4 days, but his condition did not improve and dyspnea became more serious. The chest CT indicated diffuse centrilobular nodules in both lungs at admission. Patient's bronchoalveolar (BAL) fluid was sent for metagenomic next-generation sequencing, which only supported a diagnosis of S. pneumoniae infection. His condition improved gradually after antimicrobial treatment (moxifloxacin) and a follow-up CT showed that the diffuse centrilobular nodules in both lungs were absorbed completely.

Conclusion: This case highlights a rare CT presentation of S. pneumoniae pneumonia that should alert clinicians, so as to avoid taking unnecessary treatment measures.

Keywords: Streptococcus pneumoniae; case report; centrilobular nodules; chest computed tomography; pneumonia.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

FIGURE 1
FIGURE 1
Patient’s computed tomography (CT) scan images at three time points. Initial CT scan (Day 0) showed that bilateral diffuse nodules separated by the fissures and pleura. Some of the nodules have a “tree-in-bud” appearance. After treatment, CT scan (Day 9) showed visible absorption of diffuse nodules in both lungs. Follow-up CT scan (Day 31) showed that the bilateral diffuse nodules absorbed completely.
FIGURE 2
FIGURE 2
Mediastinal window of patient’s initial computed tomography (CT) scan showed multiple enlarged lymph nodes in mediastinum and bilateral axilla.
See this image and copyright information in PMC

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