Abstract Introduction Respiratory infections are common during pregnancy and the postpartum period. Early and timely recognition is crucial. We report the case of a 25 year old female who presented to the emergency room on multiple occasions before delivery, who was ultimately diagnosed with a large right lower lobe pulmonary abscess days following delivery. She underwent an extensive serologic evaluation, bronchoscopy, and received treatment with a prolonged course of antibiotics. Case Presentation A 25 year old G2P2 female presented to the emergency room with acute onset, sharp right-sided flank pain 1 week following an uncomplicated delivery. She reported a gradually worsening productive cough without hemoptysis for the past year. On exam she was afebrile with a normal oxygen saturation with reduced breath sounds at the right lower lobe. CT chest with IV contrast revealed a 10.8 x 6.5 cm right lower lobe cavity with an fluid and air consistent with a lung abscess. Labs demonstrated mildly elevated non-specific inflammatory markers and mild microcytic anemia without leukocytosis. Serum electrolytes were unremarkable. Sputum and blood cultures did not reveal any growth. HIV, ANCA, and Quantiferon TB Gold test were negative. She had normal immunoglobulin levels. Legionella and Streptococcus urinary antigens, Coccidioides Abs, and MRSA nasal PCR were negative. She was initially treated with Piperacillin-Tazobactam and Vancomycin and bronchoscopy with bronchoalveolar lavage of the right lower lobe was performed. Fungal and mycobacterial cultures were negative. Anaerobic culture revealed growth of Prevotella melaninogenica. She was subsequently discharged from the hospital on Augmentin SR 875 mg twice daily for 8 weeks with post-treatment imaging planned. On retrospective review of available chest imaging obtained during emergency room visits while pregnant, an enlarging right lower lobe opacity could be seen (see attached pic for comparison of chest x ray and CT scan obtained in her prenatal period versus now).7 Discussion Pregnancy increases the risk for aspiration secondary to several physiological mechanisms including increased abdominal pressure, relaxation of esophageal sphincters, and delayed gastric emptying, which can lead to pulmonary complications. In this case, bronchoalveolar culture positivity for the anaerobe Prevotella supports aspiration of pharyngeal contents as a contributor to the development of this enlarging necrotizing lung abscess. A high index of suspicion is necessary during the prenatal period given the prioritization of limiting exposure to ionizing radiation during pregnancy. This abstract is funded by: None
Sivaguru et al. (Fri,) studied this question.