Pulmonary Literature Review and Complex Case Presentations Post Graduate Course-Complex_Cases_CAP_2024

Complex_Cases_CAP_2024_Restrepo

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A 48-year-old woman with a history of hypothyroidism presented with a week-long history of progressive shortness of breath, severe cough, subjective fever, and was initially treated with Amoxicillin/Clavulanate. On examination, she had decreased breath sounds on the left lung, dullness, and crackles. Her condition included episodes of cough with new instances of urinary incontinence, and an SpO2 of 84% at home. At the emergency department, her SpO2 was 85%, necessitating supplemental oxygen.<br /><br />Laboratory tests revealed elevated white blood cell counts, mild anemia, a normal liver function, and negative lactic acid levels. Admission to the hospital was warranted due to persistent hypoxemia and respiratory distress.<br /><br />Despite initial treatment with ceftriaxone and azithromycin, her symptoms persisted, and her oxygen requirements increased significantly, necessitating ICU admission. By Day 3, her situation worsened with continuous hypoxemia, leading to increased support with a high-flow nasal cannula.<br /><br />On Day 4, her viral panel indicated Mycoplasma pneumoniae, prompting the addition of doxycycline to her antibiotic regimen. Additionally, hydrocortisone was introduced, reflecting studies suggesting corticosteroids reduce 30-day mortality in severe community-acquired pneumonia (CAP). Treatment alterations led to a gradual improvement in her condition, with reduced oxygen needs by Day 5 and noteworthy recovery by Day 6-7, allowing physical activity without desaturation episodes.<br /><br />This case illustrates the challenges in managing complex pneumonia, highlighting the importance of tailored antibiotic therapy, the role of corticosteroids in severe CAP, and the use of advanced oxygen therapy to manage severe respiratory distress. It also underscores the necessity of re-evaluating treatment strategies as diagnostic results are processed, in adherence with respiratory care and infectious disease guidelines.

Keywords

hypothyroidism

shortness of breath

cough

hypoxemia

Mycoplasma pneumoniae

corticosteroids

community-acquired pneumonia

antibiotic therapy

ICU admission

oxygen therapy