# Clinical Features and Outcomes of Necrotizing Pneumonia in a Peripheral Intensive Care Unit: A Case Series

## TL;DR

This case series describes three patients with severe pneumonia who developed necrotizing pneumonia and highlights challenges in diagnosis and treatment in resource-limited settings.

## Contribution

The study presents a rare case series of necrotizing pneumonia in a peripheral ICU, emphasizing clinical progression and management challenges.

## Key findings

- Three patients with community-acquired pneumonia developed necrotizing pneumonia and required ICU admission.
- Two patients survived after transfer for ECMO evaluation, while one died due to multiorgan failure.
- The study highlights the importance of timely imaging and resource availability in managing necrotizing pneumonia.

## Abstract

Necrotizing pneumonia (NP) is a rare but severe complication of community-acquired pneumonia (CAP). We describe three consecutive adult patients admitted to a peripheral intensive care unit (ICU) in Portugal between January 2023 and October 2024, all presenting with severe CAP complicated by bacteremia (Klebsiella pneumoniae, methicillin-sensitive Staphylococcus aureus, and Streptococcus pneumoniae). All patients required invasive mechanical ventilation, with Cases 2 and 3 also requiring vasopressor support shortly after ICU admission. NP was diagnosed by chest computed tomography (CT) on days 6, 6, and 11 of hospitalization, respectively, following unexpected clinical deterioration. Two patients developed refractory acute respiratory distress syndrome (ARDS) and were transferred to a tertiary center for venovenous extracorporeal membrane oxygenation (VV-ECMO) evaluation; both survived to hospital discharge. The third patient progressed to multiorgan failure and died on day 11. This case series illustrates the rapid clinical decline that can precede radiological confirmation of NP and highlights practical challenges faced in resource-limited settings, particularly regarding timely advanced imaging and referral. Further studies are needed to determine how these factors (timing of imaging, organ support availability, and ICU resource limitations) influence outcomes.