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Case Reports
. 2024 Jun 3;16(6):e61614.
doi: 10.7759/cureus.61614. eCollection 2024 Jun.

Two Cases of Lung Abscess and Pleuritis in Severe COVID-19 Patients

Shiho Goda  1 , Tatsuya Yuba  2 , Kohei Yamamoto  1 , Misaki Sasakura  1 , Noriya Hiraoka  1
Affiliations
Case Reports

Two Cases of Lung Abscess and Pleuritis in Severe COVID-19 Patients

Shiho Goda et al. Cureus. .

Abstract

We report two patients who were treated with remdesivir, steroids, and tocilizumab for severe coronavirus disease 2019 (COVID-19) and developed lung abscesses and pleuritis. Although complications due to bacterial infections are often reported in COVID-19 patients, these severe infections are rare. Patients receiving tocilizumab are at a high risk of developing serious bacterial infections, and the diagnosis is often delayed because symptoms such as fever and elevated C-reactive protein levels are often minimal. The possibility of complications owing to severe bacterial infections should be considered when treating patients with severe COVID-19.

Keywords: covid-19; lung abscess; pleuritis; secondary bacterial infection; tocilizumab.

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Conflict of interest statement

Human subjects: Consent was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.

Figures

Figure 1
Figure 1. Chest radiography and CT images for case 1.
(A) Chest radiography upon admission for the patient in case 1 revealing consolidation in the right lower and entire left lung fields. Two nodules were observed in the left lung fields (red arrows). (B) Chest CT images upon admission for the patient in case 1 revealing extensive consolidation in the right middle and lower lobes and the entire left lobe (red arrows). (C) Contrast-enhanced chest CT images on day 13 for the patient in case 1 revealing several pulmonary abscesses in the left upper lobe (red arrows). Consolidations in the bilateral lower lobes improved.
Figure 2
Figure 2. Clinical course for case 1.
The day of symptom onset is designated as day 0. NHF: nasal high flow; mPSL: methylprednisolone; TAZ/PIPC: tazobactam/piperacillin; AMK: amikacin; VCM: vancomycin; DPT: daptomycin; CEZ: cefazolin; BT: body temperature; CRP: C-reactive protein
Figure 3
Figure 3. Chest radiography and CT images for case 2.
(A) Chest radiography upon admission for the patient in case 2 revealing consolidation in the right upper and lower lung fields. (B) Chest CT image upon admission for the patient in case 2 revealing extensive consolidation throughout the right lobe (red arrows) and very few pleural effusions in the right thoracic cavity (yellow arrows).
Figure 4
Figure 4. Clinical course for case 2.
The day of symptom onset is designated as day 0. NHF: nasal high flow; DEX: dexamethasone; CTRX: ceftriaxone; ABPC/SBT: ampicillin/sulbactam; CEZ: cefazolin; BT: body temperature; CRP: C-reactive protein
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