A Putrid Pulmonary Infection

Kelly Chenkai Fan, MD and Stephen Hughes, MD

August 5, 2015

A 52-year-old previously healthy male presents with a three-week history of pleuritic chest pain followed by four days of fevers, chills, and productive cough.  Notable history includes filling of dental caries 4 weeks prior to the onset of symptoms and significant alcohol intake of 3-4 beers daily.  Otherwise he has no medical or surgical history, no scheduled medications, and no recent travel or exposure history.  Physical exam reveals a febrile male with poor oral dentition and rales in the right mid-lung field.  His complete blood count shows a neutrophil predominant leukocytosis to 20.7 (1000/µL) and chemistry panel was unremarkable.  Chest x-ray shows a cavitary lesion measuring approximately 10cm within the right lung base.  Chest CT displays a spherical 8.9cm lesion with an air-fluid level (Figure 1).

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References:
—Herth, Felix, et al.  Endoscopic Drainage of Lung Abscesses.  Chest. 2005 Apr;127(4):1378-81.
—Merritt, Robert, et al.  Indications for surgery in patients with localized pulmonary infection.  Thorac Surg Clin. 2012 Aug;22(3):325-32. doi: 10.1016/j.thorsurg.2012.05.005.
—Raymond, Daniel.  Surgical Intervention for Thoracic Infections.  Surg Clin North Am. 2014 Dec;94(6):1283-303. doi: 10.1016/j.suc.2014.08.004. Epub 2014 Sep 29.
—Wali, Siraj O.  An update on the drainage of pyogenic lung abscesses.  Ann Thorac Med. 2012 Jan;7(1):3-7. doi: 10.4103/1817-1737.91552.

Author Biographies:

Kelly Chenkai Fan, MD, corresponding author
Dr. Kelly Chenkai Fan is currently an internal medicine resident at Scripps Green Hospital.  He graduated from UCSD School of Medicine in 2013 and wishes to pursue a career in pulmonary and critical care medicine.  His research interests include finding ways to lower the rate of COPD readmissions by optimizing outpatient treatment strategies.  He is an avid basketball player and loves traveling and exploring new places.

Stephen Hughes, MD
Dr. Stephen Hughes is currently an internal medicine resident at Naval Medical Center San Diego.  He graduated from the Uniformed Services University of the Health Sciences in 2014.  He plans to spend a few years in dive medicine prior to returning to Naval Medical Center San Diego to complete his internal medicine residency.  He is considering a career in cardiology, gastroenterology, or pulmonary and critical care medicine.  His outside hobbies include hiking and spending time with his family exploring San Diego.