Infected Emphysematous Bullae of the Lung: A Diagnostic Challenge

Abstract

Infected emphysematous bullae of the lung present a diagnostic challenge due to their rarity and diverse clinical manifestations. We report the case of a 52-year-old female with chronic respiratory symptoms, including breathlessness and dry cough, persisting for six months. Imaging studies revealed characteristic features of infected emphysematous bullae, including large thick-walled cavities with air-fluid levels and associated parenchymal compression. Biomass exposure history and microbiological analysis, which isolated methicillin-resistant coagulase-negative Staphylococcus (MRCoNS), further supported the diagnosis. The patient responded well to antimicrobial therapy with doxycycline and linezolid. This case underscores the importance of considering environmental factors and multidisciplinary collaboration in managing complex respiratory conditions. Further research is warranted to elucidate optimal management strategies for infected emphysematous bullae of the lung.

Keywords: antimicrobial therapy; biomass exposure; chronic respiratory symptoms; computed tomography; infected emphysematous bullae; methicillin-resistant coagulase-negative staphylococcus.

Figure 1. The chest X-ray PA (posteroanterior) view showing a thick-walled bulla with an air-fluid level and underlying atelectasis in the right lung (indicated by an arrow).

Figure 2. USG-guided thoracocentesis was performed, aspirating 50 cc of blood-tinged pleural fluid.

USG, ultrasound

Figure 3. (A) Large thick-walled cavity in the right hemithorax with emphysematous changes in the right upper lobe; (B) air-fluid level with underlying pleural effusion.