Abstract Cavitary lung lesions arise from a wide spectrum of clinical conditions, such as malignancies, infectious disease and autoimmune. Cavitary lung lesions in the context of community acquired pneumonia are uncommon and with pseudomonas aeruginosa being even more uncommon as a causative pathogen. The case presented is of a 46 year old male with past medical history of Type 2 diabetes, asthma and methamphetamine use who presented with altered mental status. In the ED, he was found to be hypoglycemic and was given D10 after which he became more alert and oriented. On admission, the vital signs were noted to be BP 84/59 mmHg, HR128 bmp, and oxygen saturation of 60% on room air. Subsequently, he was initiated on high flow nasal cannula with improvement in oxygenation to 95%. His lab work showed leukocytosis (14,000 cells/mL). He was started on vasopressor support for hypotension refractory to intravenous fluid resuscitation and subsequently was admitted to the ICU for septic shock. The CT chest showed extensive airspace opacities throughout the lungs and several scattered cavitary lesions. Patient was electively intubated for diagnostic bronchoscopy, which revealed mucopurulent secretions in right and left lungs. The bronchoalveolar lavage (BAL) cultures were positive for methicillin sensitive Staph aureus and Pseudomonas aeruginosa. The BAL yielded negative results for acid fast bacilli, fungal cultures and malignant cytology. Additionally, blood cultures were found to be positive for Pseudomonas aeruginosa. His serum serology was negative for coccidioidomycosis. He was initiated on Meropnenem based on sputum and blood culture sensitivities. Ultimately, it was deemed that his hypoxic respiratory failure is a result of pseudomonas cavitary pneumonia. Patient’s hospital course was complicated by acute respiratory distress syndrome (ARDS), which posed a challenge for extubation. He was prone for 16-20 hours with significant improvement. Unfortunately, he suffered from a pulseless electricity activity (PEA) cardiac arrest from worsening septic shock and did not achieve return of spontaneous circulation (ROSC). It is widely known that Pseudomonas aeruginosa causes nosocomial infections; however, it is rarely associated with causing community acquired pneumonia. When patients with community acquired pneumonia display unusual rapid growth despite being on appropriate antibiotics, Pseudomonas aeruginosa should remain on list of differentials as a causative agent. This abstract is funded by: None
Zahid et al. (Fri,) studied this question.