Life-saving left completion pneumonectomy for lung abscess due to Pseudomonas aeruginosa: a case report

TL;DR

A rare case of Pseudomonas aeruginosa lung abscess leading to septic shock was successfully treated with emergency surgery and antibiotics.

Contribution

Highlights the importance of early diagnosis and surgical intervention in severe P. aeruginosa lung abscess cases.

Findings

P. aeruginosa can cause severe community-acquired lung abscess in healthy adults.

Emergency left completion pneumonectomy improved outcomes when antibiotics failed.

Early recognition and treatment of P. aeruginosa infection may prevent life-threatening complications.

Abstract

Pseudomonas aeruginosa is typically an opportunistic pathogen but, on rare occasions, may cause community-acquired pneumonia in healthy adults, often resulting in rapid and severe clinical deterioration. This case report details the successful management of a P. aeruginosa-induced community-acquired lung abscess in a patient who had fully returned to normal daily life 1 year and 5 months after a left upper lobectomy.

A 63-year-old woman underwent video-assisted thoracoscopic left upper lobectomy with lymph node dissection for lung squamous cell carcinoma 1 year and 5 months prior. She received four courses of adjuvant chemotherapy postoperatively and remained recurrence-free. The patient presented with cough and fever and was diagnosed with a pulmonary abscess characterized by extensive infiltrative shadowing with cavitation in the left lower lobe. She developed septic shock requiring vasopressor support. On hospital day 3, worsening pulmonary infiltrates and altered consciousness prompted an emergency left completion pneumonectomy for infection source control, as antibiotic therapy alone was insufficient. Postoperative culture confirmed Pseudomonas aeruginosa. Although two subsequent hematoma evacuations and drainage were required, the patient recovered and was discharged on postoperative day 39.

We present a rare case of P. aeruginosa community-acquired lung abscess complicated by septic shock. In rapidly progressive cases, early consideration of P. aeruginosa infection, prompt administration of antibiotics with anti-P. aeruginosa activity, and early assessment for surgical intervention may improve patient outcomes.

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