Necrotizing pneumonia in children: a case series

Necrotizing pneumoniae (NP) is a serious complication of community acquired pneumonia.Streptococcus pneumoniae is the most common cause of NP.Contrast-enhanced computerized tomography (CT) is more sensitive than plain radiographs for detecting suppurative complications of pneumoniae.NP requires a prolonged course of antimicrobial therapy, usually starting by the parental route.We present a case-series of 4 pediatric cases of NP, comparing the observed data with those described in the current literature.The clinical presentation and laboratory examinations were consistent with those reported in the literature.In most of our cases we made the diagnosis with contrast-enhanced computed tomography, however recent advances in magnetic resonance imaging sequences and protocols have made it a viable alternative for the diagnosis, as shown in 1 of our patients.As suggested by literature, the initial empiric therapy was broad-spectrum modified with a targeted therapy according to the antibiogram.There are only few studies that have evaluated longterm follow-up in patients who had NP.Lung function tests were initially altered in 2 out of 4 patients and chest x ray normalized in 6 months at maximum in all the 4 patients.2 cases out of 4 underwent magnetic resonance imaging (MRI) after 10 months from the discharge.In both cases it showed persistent minimal residual signs of previous NP.We conclude that early diagnosis and adequate therapy are essential to prevent severe consequences and impairment of lung function.More studies are needed to define the follow-up, as early pneumonia could be a risk factor for impaired pulmonary function in adulthood.