Necrotising Pneumonia with Empyema Thoracis

A 4-year-old boy was admitted to Max Super Specialty Hospital, Shalimar Bagh, with a high-grade fever for ten days, with no history of cough or coryza. He was quite unwell, toxic with mild tachypnoea, and no respiratory difficulty. He was on antibiotics.

X-ray chest showed left lower lobe pneumonia. The clinical examination revealed reduced air entry on the left side and bronchial breathing over the left intra-axillary areas. Chest X-ray showed opacity in the left lower lobe, and a CT scan showed extensive collapse consolidation on the left side with necrosis and pleural effusion. Ultrasound-guided aspiration of effusion was attempted but was not successful. CT-guided diagnostic pleural tap was done, which revealed empyema high cell count AFB stain negative. Gene expert was negative and pyogenic culture was also negative.

The patient was treated with IV antibiotics for 14 days, followed by oral antibiotics.
Generally, patients with Necrotising Pneumonia with Empyema Thoracis require pus drainage, thoracocentesis or intrapleural fibrinolytic therapy. If the patient's condition doesn’t improve, then open thoracotomy or video-assisted thoracoscopic surgery and decortication is suggested or done. However, the child improved with antibiotics.

The patient was discharged after ten days and continued oral antibiotics for two weeks. His fever settled after seven days. He resumed his school and other activities of daily life.