Bacteroides fragilis Pneumonia and Empyema in a Child with Down Syndrome

A 10-year-old female with Down syndrome was admitted with a 5-day history of fever, rigors, and progressive dyspnea. Admitting assessment revealed the presence of a right-sided Bacteroides fragilis pneumonia and empyema. Shortly after admission, the child's respiratory condition deteriorated when she drained an unsuspected right lung abscess into the opposing lung. She was placed on assisted ventilation and intravenous clindamycin with gradual improvement in her clinical condition. Because patients with Down syndrome have oropharyngeal anatomical abnormalities and low esophageal muscle tone, they are prone to develop aspiration pneumonias involving oropharyngeal flora, including B. fragilis.