Pneumonia Necrotizante A Propósito de Um Caso Clínico

Prazeres, T.; Dias, A.; Moura, R.; Fernandes, A.; Aguiar, I.; Lobo, A.

http://hdl.handle.net/10400.16/668

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ABSTRACT Introduction. Necrotizing Pneumonia (NP) is a serious complication of Community Acquired Pneumonia, whose incidence has been increasing in recent years. The authors present a case report of a child with NP and make a comprehensive review of the subject. Case report. A 22 months old girl, without history of relevant diseases, presented in Hospital because of high fever lasting six days. She appeared ill and septic, with severe respiratory distress, pallor, increased capillary refi lling time and defense to abdominal palpation. Serum analysis showed anaemia, neutrofi lia and elevated Reactive-C-Protein (393 mg/L). The thoraco-abdominal CT scan showed evidence of a large parenquimal consolidation involving the upper and lower lobes of the right lung. Due to unfavourable evolution after four days of antibiotics, she underwent thoracic CT scan that showed necrotizing phenomena of the right upper lobe associated with liquid collections, and therefore, intravenous clindamycin was associated to the treatment. She completed four weeks of antibiotherapy with a favourable outcome. Comments. Typically, children with NP appear ill and present with high fever, respiratory distress and hypoxemia; the diagnosis must be considered in all children with pneumonia presenting an unfavourable evolution. The CT scan is the gold-standard exam for the diagnosis. Antibiotic regimen should be long (normally four weeks), being vancomycin and clindamycin the preferred antibiotics. Conservative treatment appears to have good results and surgery is reserved for selected cases. Although it may be a severe disease in the acute stage, pediatric NP has a good outcome with clinical resolution in two months’ and minimal sequelae.