Author(s): Nasr E.
Source: American Journal of Respiratory and Critical Care Medicine; 2018; vol. 197
Publication Date: 2018
Publication Type(s): Conference Abstract
Available at American Journal of Respiratory and Critical Care Medicine – from Edge Hill Aintree LIRC (lib302411) Local Print Collection [location] : Edge Hill Aintree LIRC.
Abstract:Dr.E.Nasr MBBS Aintree University Hospital INTRODUCTION- Case of a woman who presented to A&E with breathlessness and diarrhoea following a trip to India. A 73 year old woman who had been visiting India with her brother developed loose stool and breathlessness during the last 2 days of her trip. She presented to primary care on returning to England and was offered a course of amoxicillin to treat a lower respiratory tract infection. Her symptoms continued to worsen despite treatment and she presented to the accident and emergency department 1 week later. She was in Type 1 Respiratory Failure with metabolic acidosis. Due to severe hypoxia she was intubated and admitted to the Critical Care Unit. Fig1-CXR showing opacity occupying the right hemithorax CT Scan-Fig2 The CT scan was initially reported overnight by the radiology registrar as a “Highly vascularised mass lesion occupying the majority of the right hemithorax -9x15cm in the axial plane-causing compression of the adjacent lung”. The following day an addendum was added to the report by the radiology consultant as follows “Right upper lobe pneumonia with a bulging fissure and passive collapse of the mid and lower lobes.” DIFFERENTIAL DAGNOSES – Expansile pneumonia Neoplasia Lymphoma Tuberculosis. INVETSTIGATIONS- . Bronchoscopy- No endobronchial masses. Necrotic airways right upper lobe-suggestive of necrosing pneumonia. Purulent secretions in the right upper lobe. Samples sent for microscopy and culture, virology and cytology. . Urinary Legionella Antigen – POSITIVE . Broncho-alveolar Lavage- Legionella Pneumophilia . Throat Swab- Influenza A Positive CONCLUSION- A case of legionella pneumophilia with co-infection of influenza A that resulted in unusual appearance on CXR and CT thorax. She was treated with Intravenous antibiotics and mechanical ventilation. Extubating her prove difficult due to inability to appropriately wean off sedation. She underwent a percutaneous tracheostomy insertion and this helped to facilitate weaning sedation and ventilation requirements. (Figure presented) .