NECROTIZING PNEUMONIA CAUSED BY STREPTOCOCCUS PNEUMONIAE IN A FIVE-YEAR-OLD BOY - A CASE REPORT

Abstract

Introduction: Necrotizing pneumonia is one of the most serious complications of community-acquired pneumonia, caused by infection with particularly virulent bacteria. Streptococcus pneumoniae is the most common agent. It typically occurs in previously healthy children and leads to a prolonged clinical course despite appropriate antibiotic therapy.

Case outline: A five-year-old boy, who was regularly vaccinated and had no chronic illnesses, presented with a 14-day history of fever and cough, followed by difficulty breathing and right-sided abdominal pain. Oral antibiotic therapy (azithromycin) was started just before admission. As the symptoms persisted, radiological diagnostics were performed, and the diagnosis of pleuropneumonia was made, leading to hospitalization. Upon admission to the hospital an ultrasound and chest computed tomography were performed, confirming bilateral necrotizing pneumonia with massive right-sided pleural effusion, as well as thrombosis at the junction of the left jugular and subclavian vein. Treatment included parenteral antibiotic therapy, thoracic drainage with the administration of alteplase, and anticoagulant therapy. The pleural effusion, based on its biochemical characteristics, corresponded to empyema, and the culture was positive for Streptococcus pneumoniae. The disease required a prolonged hospitalization of 24 days with a positive clinical outcome.

Conclusion: The diagnosis of necrotizing pneumonia should be considered in any child with pneumonia that does not improve 72 hours after appropriate antibiotic therapy. Early diagnosis and timely treatment are crucial for a positive outcome, while regular vaccination remains the primary preventive measure.