A Case of Streptococcus Pneumoniae Necrotizing Pneumonia with Pneumothorax and Abscess Formation

A 63-year-old female with a past medical history of left breast ductal carcinoma in situ, now post-left-sided lumpectomy and radiation in 2005, presented to an outside hospital with chest pain and a cough productive of green sputum. Computed tomography (CT) chest demonstrated patchy ground-glass opacities and dense consolidations in the right middle and lower lobe. Blood cultures and bronchoalveolar lavage culture were positive for Streptococcus pneumoniae, and she was started on antibiotics for community-acquired pneumonia. Her respiratory status rapidly worsened and she required intubation. She developed a large right-sided pneumothorax and had a chest tube placed for a right pleural effusion in the setting of a new lung abscess. Repeat CT chest showed necrotizing right lower lobe pneumonia. The patient was transferred to Thomas Jefferson University Hospital for further management. Throughout the patient’s hospital course, her respiratory status continued to worsen despite antibiotics, inhaled epoprostenol, paralytics, and sedatives. She required tracheostomy placement and a repeat chest tube placement. Repeat CT chest showed a persistent large right-sided pneumothorax (blue arrows), worsening multifocal consolidations (red arrows), areas of cavitation (white arrows), and ground-glass opacities. The patient was transitioned to comfort care and expired. This case serves to highlight an aggressive case of necrotizing Streptococcus pneumoniae pneumonia.