Community-Acquired Necrotizing Pneumonia with Bronchopleural Fistulas Due to Streptococcus pneumoniae in an Adult

Abstract

Background: Necrotizing pneumonia with subsequent bronchopleural fistula attributable to Streptococcus pneumoniae infection has not been reported in adults.

Case presentation: We here firstly report a case of 23-year-old female with severe community-acquired multiple lung abscesses due to Streptococcus pneumoniae in the left lower lung, which merged and ruptured, further leading to the development of bronchopleural fistulas. After adequate anti-infective treatment and repairing the fistulas under thoracoscopy, the pulmonary infection was under control, and the fistulas were closed. A follow-up chest CT demonstrated the complete resolution of lung abscesses.

Conclusion: This case shows the possibility that necrotizing pneumonia due to Streptococcus pneumoniae infection can lead to bronchopleural fistula in adults. Early diagnosis and management of bronchopleural fistula are crucial for improving patients outcomes.

Keywords: Streptococcus pneumoniae; bronchopleural fistula; lung abscess; necrotizing pneumonia.

Figure 1

Chest images from one day prior to admission. Chest CT (A and B) and chest X-ray (C) showed consolidation in both lungs, with a notably extensive area of consolidation in the lower left lung.

Figure 2

Chest X-ray on the fourth day of hospitalization revealed a left-sided loculated pneumothorax (red arrow).

Figure 3

Chest CT and X-ray on the fifteenth day of hospitalization. (A) Multiple cavitations and patchy consolidations in both lungs, loss of normal structure in the left lower lung, ground-glass opacities in the right lower lung. (B) and (C) Left pleural gas with small amount of pleural effusion.

Figure 4

Diagnosis and treatment of multiple bronchopleural fistulas via thoracoscopy on the sixteenth day of hospitalization. (A) Multiple fistulas (black arrows) on the visceral pleura with significant necrotic material. (B) Methylene blue (black arrow) injected through bronchoscopy into the left lower lobe bronchus flowed out from the fistulas under thoracoscopy. (C) Argon plasma coagulation cauterization of the fistulas, followed by spraying of fibrin glue and thrombin.

Figure 5

Follow-up chest CT and X-ray seven weeks post-discharge showed a remarkable improvement. (A) Complete closure of multiple cavitations in both lungs, and residual slight traction bronchiectasis in the left lower lung. (B) and (C) Residual small amount of encapsulated pleural gas and effusion.