Revista multidisciplinaria
investigación Contemporánea ISSN-e: 2960-8015Vol. 3 -No. 207 - 2025
Pneumonia Complicated by Lung Abscess and Pleural Effusion.
Case Report and Review of the Literature
DOI: https://doi.org/10.58995/redlic.rmic.v3.n2.a105
131-147
Pneumonia Complicated by Lung
Abscess and Pleural Effusion. Case
Report and Review of the Literature
Neumonía Complicada por AbscesoPulmonar y
Derrame Pleural. Presentación de un caso y revisión
de la literatura
Evelyn Yomilda Miranda Macias 1 , Tania Teresa Ortiz Jumbo 2, *, Juan Gregorio Chang Asinc 3
1 Pediatric Postgraduate Fellow , Roberto Gilbert Children’s Hospital, Guayaquil Charity Board;
dra.mirandamaciasevelyn@gmail.com, Guayaquil Ecuador.
2 Pediatric Postgraduate Fellow, Roberto Gilbert Children’s Hospital, Guayaquil Charity Board;
tania.ortizj@hotmail.com, Guayaquil Ecuador.
3 Specialist Physician, Roberto Gilbert Children’s Hospital, Guayaquil Charity Board;
jgca76@yahoo.com. Guayaquil Ecuador.
How to cite:
Miranda Macias, E. Y., Ortiz Jumbo, T. T., & Chang Asinc, J. G. (2025). Pneumonia Complicated by Pulmonary
Abscess and Pleural Effusion. Case presentation and literature review. Multidisciplinary Journal of
Contemporary Research, 3(2), 131-147. https://doi.org/10.58995/redlic.rmic.v3.n2.a105
Article Information
Received: 19-01-2025
Accepted: 25-03-2025
Published: 01-07-2025
Editor’s Note
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claims in published messages and institutional
afliations.
Editorial
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Contemporary Research (REDLIC)
www.editorialredlic.com
Funding Sources
The research was conducted using the authors’
own resources.
Conicts of Interest
No conicts of interest are declared.
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Revista multidisciplinaria
Investigación Contemporánea 07 - 2025 Vol. 3 - No. 2 ISSN-e: 2960-8015
DOI: https://doi.org/10.58995/redlic.rmic.v3.n2.a90
Leucemia de células dendríticas plasmocitoides
- estudio y diagnóstico de un caso 49 -49
Copyright (c) 2025 Faicán Rocano Pedro Fernando, Dután Pérez Ibelice Salomé,
González González Camila Raquel, Matute Aguiar Joselyn Nayeli, Rodríguez Ver-
dugo Alejandra Valentina.
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Review article. Revista Multidisciplinaria Investigación Contemporánea.
Vol. 3 - No. 2, pp. 131 - 147. July-December, 2025. e-ISSN: 2960-8015
DOI: https://doi.org/10.58995/redlic.rmic.v3.n2.a105
Revista multidisciplinaria
Investigación Contemporánea 07 - 2025 Vol. 3 - No. 2 ISSN-e: 2960-8015
DOI: https://doi.org/10.58995/redlic.rmic.v3.n2.a90
Leucemia de células dendríticas plasmocitoides
- estudio y diagnóstico de un caso 32 -49
Artículo Caso clínico. Revista multidisciplinaria investigación Contemporánea.
Vol. 3 - No. 2, pp. 32 - 49. julio-diciembre, 2025. e-ISSN: 2960-8015
Leucemia de células dendríticas
plasmocitoides - estudio y diagnóstico
de un caso
Leucemia de células dendríticas plasmocitoides - estudio y
diagnóstico de un caso
Información del artículo:
Recibido: 05-12-2024
Aceptado: 21-02-2025
Publicado: 01-07-2025
Nota del editor:
REDLIC se mantiene neutral con respecto a
reclamos jurisdiccionales en mensajes publi-
cados y aliaciones institucionales.
Editorial:
Red Editorial Latinoamericana de Investigación
Contemporánea (REDLIC) www.editorialredlic.com
Fuentes de nanciamiento:
La investigación fue realizada con recursos propios.
Conictos de interés:
No presentan conicto de intereses.
Este texto está protegido por una licencia Creative Commons 4.0.
Usted es libre para Compartir —copiar y redistribuir el material en cual-
quier medio o formato— y Adaptar el documento —remezclar, transformar
y crear a partir del material— para cualquier propósito, incluso para nes
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Atribución: Usted debe dar crédito a la obra original de manera adecuada,
proporcionar un enlace a la licencia, e indicar si se han realizado cambios.
Puede hacerlo en cualquier forma razonable, pero no de forma tal que sugie-
ra que tiene el apoyo del licenciante o lo recibe por el uso que hace de la obra
1 Docente Investigador; pedro.faican@ucacue.edu.ec. Azogues, Ecuador.
2 Estudiante; ibelice.dutan.44@est.ucacue.edu.ec. Azogues, Ecuador.
3 Estudiante; camila.gonzalez.66@est.ucacue.edu.ec. Azogues, Ecuador.
4 Estudiante; joselyn.matute.44@est.ucacue.edu.ec. Azogues, Ecuador.
5 Estudiante; alejandra.rodriguez.60@est.ucacue.edu.ec. Azogues, Ecuador.
Faicán Rocano Pedro Fernando 1, Dután Pérez Ibelice Salomé 2, González González Camila
Raquel 3, Matute Aguiar Joselyn Nayeli 4, Rodríguez Verdugo Alejandra Valentina 5
DOI: https://doi.org/10.58995/redlic.rmic.v3.n2.a90
Cómo citar:
Faican Rocano, P. . F., Dután Pérez, I. S. ., González González, C. R. ., Rodríguez Verdugo, A. V. ., & Matute Aguiar, J.
N. . (2025). Leucemia de células dendríticas plasmocitoides - estudio y diagnóstico de un caso.
Revista Multidisci-
plinaria Investigación Contemporánea
, 3(2), 32-49. https://doi.org/10.58995/redlic.rmic.v3.n2.a90
Revista multidisciplinaria
investigación Contemporánea ISSN-e: 2960-8015Vol. 3 -No. 207 - 2025
Pneumonia Complicated by Lung Abscess and Pleural Effusion.
Case Report and Review of the Literature
DOI: https://doi.org/10.58995/redlic.rmic.v3.n2.a105
132-147
Summary
Pneumonia is an acute lung infection that can lead to serious complications,
such as lung abscesses and pleural effusions. It is estimated to account for 15% of
hospitalizations in children under 5 years of age, and complications occur in 5–10%
of cases. In this context, we present the clinical case of a 5-year-old patient with
cough, high fever, and respiratory distress, supported by clinical and laboratory
criteria conrming the diagnosis of complicated pneumonia. Furthermore, we
review the literature on the disease, its complications, diagnosis, and treatment,
emphasizing that proper detection and management are crucial to reduce the
incidence of complications and promote effective recovery. This case underscores
the complexity of managing complicated pneumonia in pediatrics, where surgical
intervention was essential. Multidisciplinary follow-up facilitated recovery,
highlighting the importance of early diagnosis and appropriate treatment.
Keywords: complicated pneumonia, lung abscess, pleural effusion, surgical
intervention, multidisciplinary treatment, diagnosis.
Resumen
La neumonía es una infección pulmonar aguda que puede provocar complicaciones
graves, como abscesos pulmonares y derrames pleurales. Se estima que es
responsable del 15% de las hospitalizaciones en niños menores de 5 años, y las
complicaciones ocurren en el 5-10% de los casos. En este contexto, se presenta el
caso clínico de un paciente de 5 años con tos, ebre alta y dicultad respiratoria,
respaldado por criterios clínicos y de laboratorio que conrman el diagnóstico
de neumonía complicada. Además, se revisa la literatura sobre la enfermedad,
sus complicaciones, diagnóstico y tratamiento, enfatizando que la detección y el
manejo adecuados son cruciales para disminuir la incidencia de complicaciones
y favorecer una recuperación efectiva. Este caso subraya la complejidad del
manejo de la neumonía complicada en pediatría, donde la intervención quirúrgica
fue fundamental. El seguimiento multidisciplinario facilitó la recuperación,
resaltando la importancia del diagnóstico temprano y un tratamiento adecuado.
Palabras clave: neumonía complicada, absceso pulmonar, derrame pleural,
intervención quirúrgica, tratamiento multidisciplinario, diagnóstico.
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investigación Contemporánea ISSN-e: 2960-8015Vol. 3 -No. 207 - 2025
Pneumonia Complicated by Lung Abscess and Pleural Effusion.
Case Report and Review of the Literature
DOI: https://doi.org/10.58995/redlic.rmic.v3.n2.a105
133-147
1. Introduction
Pneumonia is an acute infection of the pulmonary parenchyma
that can be caused by various pathogens, including bacteria, viruses,
and fungi. This disease represents one of the leading causes of morbidity
and mortality in the pediatric population worldwide. According to
the World Health Organization (WHO), pneumonia is responsible for
approximately 1.5 million deaths annually in children under ve years of
age, which underscores the importance of its prevention and appropriate
treatment [1]. The clinical presentation of pneumonia can vary from mild
forms, which are managed as an outpatient, to severe forms requiring
hospitalization and intensive care.
The prevalence of pneumonia varies signicantly by geographic
region, socioeconomic status, and patient age. A study by Liu et al. (2019)
reported that the prevalence of pneumonia in children under ve years
of age in developing countries is approximately 20% to 30%, while in
developed countries, the gure is considerably lower, around 5% [2]. This
disparity highlights the need for targeted interventions in vulnerable
populations and access to adequate medical care.
Complications associated with pneumonia, such as pleural effusion
and lung abscess, are of particular concern in pediatric management. These
complications may arise due to inammation and uid accumulation
in the pleural cavity, which may require invasive procedures such
as thoracentesis or video-assisted thoracoscopy for resolution [3].
Pneumonia is the leading cause of pleural effusion (PE) in children, and
approximately 20–40% of children present with it. Early identication of
these complications is crucial to improve clinical outcomes and reduce
associated mortality.
Research in the eld of pneumonia has advanced in recent decades,
with an increasing focus on identifying risk factors, improving treatment
strategies, and implementing vaccination programs. The introduction of
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investigación Contemporánea ISSN-e: 2960-8015Vol. 3 -No. 207 - 2025
Pneumonia Complicated by Lung Abscess and Pleural Effusion.
Case Report and Review of the Literature
DOI: https://doi.org/10.58995/redlic.rmic.v3.n2.a105
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Revista multidisciplinaria
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DOI: https://doi.org/10.58995/redlic.rmic.v3.n2.a105
Neumonía Complicada por Absceso Pulmonar y Derrame Pleural.
Presentación de un caso y revisión de la literatura 134 - 147
programas de vacunación. La introducción de vacunas contra el neumococo
y la inuenza ha demostrado ser efectiva en la reducción de la incidencia de
neumonía en la población pediátrica (4). Sin embargo, a pesar de estos avan-
ces, la neumonía sigue siendo un desafío signicativo en la salud pública, es-
pecialmente en contextos de pobreza y falta de acceso a atención médica.
El objetivo de esta investigación es describir un caso clínico de neumo-
nía con complicaciones, especícamente asociado a la presencia de derrame
pleural, abordando las características clínicas, métodos diagnósticos em-
pleados, evolución del paciente y las intervenciones terapéuticas realizadas
para su manejo integral.
2. Caso Clínico
Un paciente masculino, 5 años, con vacunas incompletas hasta el año de edad,
su carnet reporta pendiente Varicela (15 meses) y DPT de los 18 meses (pri-
mer refuerzo), como antecedente de importancia una hospitalización en otra
casa de salud por 5 días por presentar insuciencia respiratoria, que se com-
paña de tos húmeda, emetizante en una ocasión de contenido alimentario.
Durante dicha hospitalización cursa con ebre de alto grado 39.9°c que cedía
parcialmente al antipirético, debuta con dicultad respiratoria caracterizada
por taquipnea, al no presentar mejoría familiar solicita alta voluntaria y acu-
den por sus propios medios a nuestra casa de salud.
A su llegada con soporte de mascarilla de no reinhalación luce deshi-
dratado con aspecto pálido, en lo cardio respiratorio se observa aleteo na-
sal, taquicárdico, taquipneico, en el (p90-99) para la edad, a la auscultación,
entrada regular de aire, hipoventilación en pulmón izquierdo presenta di-
cultad respiratoria, llenado capilar prolongado de 4 segundos, temperatura
de 37.3 °C y tos persistente. Valorado con score de Score de Wood Downes
6p-Moderada.
Dentro de nuestras primeras intervenciones se coloca oxígeno por AF
16 Litros con FiO2 50%, dentro de los exámenes de laboratorio destacaron
un hemograma que evidencia leucocitosis 22.800 asociado a neutrolia y un
pneumococcal and inuenza vaccines has proven effective in reducing the
incidence of pneumonia in the pediatric population [4]. However, despite
these advances, pneumonia remains a signicant public health challenge,
especially in contexts of poverty and lack of access to health care.
The objective of this research is to describe a clinical case of
pneumonia with complications, specically associated with the presence
of pleural effusion, addressing the clinical characteristics, diagnostic
methods used, patient evolution and therapeutic interventions performed
for its comprehensive management.
2. Clinical case
A 5-year-old male patient, with vaccinations up to one year of age
in his card, reports incomplete and pending Chickenpox (15 months) and
DPT at 18 months (rst booster), as a signicant history of hospitalization
in another health center for 5 days due to respiratory failure, accompanied
by a wet cough, emetizing on one occasion with food content. During
this hospitalization, he presented with a high-grade fever of 39.9 ° C that
partially responded to antipyretics, he began with respiratory difculty
characterized by tachypnea, as there was no improvement in the family,
he requested voluntary discharge and came to our health center on their
own.
On arrival, with support of a non-rebreathing mask, he appears
dehydrated with a pale appearance. Cardiorespiratory examination
shows nasal aring, tachycardic, tachypneic, in (p90-99) for his age. On
auscultation, regular air entry, hypoventilation in the left lung, he presents
respiratory difculty, prolonged capillary rell of 4 seconds, temperature
of 37.3 ° C and persistent cough. Evaluated with a Wood Downes Score of
6p - Moderate.
Among our rst interventions, oxygen was placed by AF 16 Liters
with FiO2 50%. Among the laboratory tests, a complete blood count
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investigación Contemporánea ISSN-e: 2960-8015Vol. 3 -No. 207 - 2025
Pneumonia Complicated by Lung Abscess and Pleural Effusion.
Case Report and Review of the Literature
DOI: https://doi.org/10.58995/redlic.rmic.v3.n2.a105
135-147
showed leukocytosis 22,800 associated with neutrophilia and a CRP 268
in the context of clinical symptoms with PEWS assessment of 4 points, and
it was decided to hospitalize and expand the studies.
A chest X-ray was performed, which showed left basal radiopacity
with blurring of the left costodiaphragmatic angle, and a chest computed
tomography with a pulmonary window showed or showed a lung abscess
in the lower lobe and free uid in the left pleura. Evaluated by the
infectious disease service, who initially prescribed IV Ceftriaxone 75 mg/
kg/day every 24 hours and IV Clindamycin 40 mg/kg/day every 6 hours.
Serological studies included blood cultures and urine culture, without
bacterial growth, swabs for viral uptake upon admission for RSV, and PCR
for COVID, which were negative.
The patient remains in regular clinical condition with oxygen support
via a high-ow nasal cannula. He persists with respiratory difculty and
is reassessed with a 3-point Wood Downes test. He was evaluated by the
pediatric surgery service, who reported that the patient required surgical
treatment. Prior to improving hemodynamics, a red blood cell transfusion
was indicated due to a hemoglobin level of 8.4 and a hematocrit of 24.2. He
was scheduled for diagnostic video-assisted thoracoscopy + pulmonary
decortication with brin removal + placement of a left chest tube +
placement of a left subclavian central venous catheter. The ndings were:
Pachypleuritis, multiple brin collections, abscess in the lower lobe,
lateral basal segment, and free uid in the pleura of 50cc. 5 days after his
rst intervention, he was scheduled with the pediatric surgery service for
a left lower lobectomy + pleural cavity lavage + chest tube placement +
pleurovac change. Findings: Cavitary lesion with necrosis and abundant
brin involving the left lower lobe. The following studies were performed
as part of the approach:
1. Pleural uid: Cytological - cytochemical: cloudy appearance,
leukocytes 0.721, 10 ´3/ul polymorphonuclear 89.8%, glucose 7.42,
proteins 5.19 g/dl, LDH 5215 U/L, rivalta negative
Revista multidisciplinaria
investigación Contemporánea ISSN-e: 2960-8015Vol. 3 -No. 207 - 2025
Pneumonia Complicated by Lung Abscess and Pleural Effusion.
Case Report and Review of the Literature
DOI: https://doi.org/10.58995/redlic.rmic.v3.n2.a105
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DOI: https://doi.org/10.58995/redlic.rmic.v3.n2.a105
Neumonía Complicada por Absceso Pulmonar y Derrame Pleural.
Presentación de un caso y revisión de la literatura 136 - 147
Abordado en cuidados intermedios en contexto de su cuadro clínico
se considera ante neumonía complicada, con hallazgos de absceso en pul-
món izquierdo, descartándose ya tuberculosis, su cobertura antimicrobiana
ante los hallazgos imagenológicos sugestivos de absceso pulmonar, el esque-
ma antibiótico fue modicado para enfocarse principalmente en gérmenes
Gram positivos, como Streptococcus pneumoniae y Staphylococcus aureus.
El servicio de infectología indicó el uso de ceftriaxona (75 mg/kg/día IV cada
24 horas) y vancomicina (40 mg/kg/día IV cada 6 horas), completando un es-
quema de tratamiento de 21 días. Además, durante la hospitalización, a los 14
días debuta cuadro clínico con sospecha de infección de etiología viral que
se acompaña de rinorrea hialina abundante y se solicita hisopado para virus
respiratorio dando positivo en parainuenza 1. Su manejo fue sintomático.
La evolución clínica del paciente fue progresivamente favorable. En la fase
nal de hospitalización, se encontraba hemodinámicamente estable, cons-
ciente, alerta y con movilidad conservada, sin signos de dicultad respira-
toria. La auscultación reveló una buena ventilación del campo pulmonar
derecho y una leve hipoventilación en el izquierdo. La herida quirúrgica co-
rrespondiente al tubo de tórax se encontraba en proceso adecuado de cica-
trización. Como parte de la rehabilitación respiratoria, realizó ejercicios con
espirómetro incentivador (triow) cada 4 horas, con buena tolerancia oral y
sin manifestaciones digestivas relevantes.
Los exámenes de control evidenciaron una normalización progresiva de
los parámetros inamatorios: leucocitos 6.780/μL, neutrólos 41%, linfoci-
tos 39%, hemoglobina 11.7 g/dL, hematocrito 33.8%, plaquetas 447.000/μL,
y proteína C reactiva (PCR) de 3.69 mg/dL. La biopsia pulmonar reportó un
exudado brino-leucocitario sin presencia de estroma, sin evidencia de gra-
nulomas ni microorganismos patógenos. Por su parte, el ecocardiograma de
control descartó compromiso cardíaco o derrame pericárdico.
Dado el estado clínico favorable y la resolución progresiva del cuadro, se de-
cidió el alta hospitalaria, con seguimiento ambulatorio por las especialidades
correspondientes y con la indicación de completar el esquema de vacunación
conforme al calendario nacional.
2. Gram stain and Ziehl stain, culture and PCR/Tb DNA of pleural
uid: negative.
3. Gram stain, Ziehl stain, culture and PCR/Tb DNA of gastric aspirate:
negative.
Approached in intermediate care in the context of his clinical
picture, he is considered to have complicated pneumonia, with ndings
of an abscess in the left lung, tuberculosis has already been ruled out. His
antimicrobial coverage should be directed especially at Gram-positive
germs: Streptococcus pneumoniae, S. aureus. The infectious disease
service suggests management with Ceftriaxone and vancomycin for 21
days. Intravenous antibiotic treatment is prescribed with Ceftriaxone 75
mg/kg/day IV every 24 hours and Vancomycin 40 mg/kg/day IV every 6
hours, completing the regimen for 21 days.
Furthermore, during hospitalization, on day 14, the patient developed
a clinical picture with suspected viral infection accompanied by abundant
hyaline rhinorrhea. A swab for respiratory virus was requested, which was
positive for parainuenza 1. His management was symptomatic.
His evolution was favorable, before being discharged he was found
hemodynamically stable, neurologically alert, mobility preserved,
connected, with no signs of respiratory distress, right lung eld well
ventilated, left lung eld slightly hypoventilated, chest tube wound
healed, he performed respiratory exercises with triow (respiratory
incentive spirometer) every 4 hours, with adequate oral tolerance, without
signs of abdominal alarm, having control analysis leukocytes: 6.78 with
neutrophils: 41, lymphocytes: 39, hemoglobin: 11.7, hematocrit: 33.8,
platelets: 447, CRP: 3.69. Biopsy: Leukocyte brin exudate devoid of stroma.
No granulomas or pathogenic microorganisms were identied. Control
echocardiogram reported as normal, without pericardial effusion. Patient
did not present fever peaks and showed improvement in respiratory
distress. The patient was kept under surveillance and discharge was
scheduled with instructions for outpatient follow-up, follow-up by
specialists, and the recommendation to complete the pending vaccination
schedule.
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investigación Contemporánea ISSN-e: 2960-8015Vol. 3 -No. 207 - 2025
Pneumonia Complicated by Lung Abscess and Pleural Effusion.
Case Report and Review of the Literature
DOI: https://doi.org/10.58995/redlic.rmic.v3.n2.a105
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Revista multidisciplinaria
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DOI: https://doi.org/10.58995/redlic.rmic.v3.n2.a105
Neumonía Complicada por Absceso Pulmonar y Derrame Pleural.
Presentación de un caso y revisión de la literatura 137 - 147
1.1. Figuras, Tablas y Esquemas
Tabla 1.
Exámenes auxiliares realizados al paciente
Exámenes de Laboratorio Resultados Valor Referencial
Biometría Hemática
Leucocitos: 22,800 /uL 4,000–10,000 /uL
Neutrólos: 76.1% 40%–75%
Linfocitos: 12.3% 20%–45%
Hemoglobina: 8.4 g/dL 11.5–15.5 g/dL
Hematocrito: 24.2% 34%–44%
Plaquetas: 750,000 /mm³ 150,000–450,000 /mm³
PCR: 268 mg/dL < 5 mg/dL
PCT: 1.13 mg/dL < 0.5 mg/dL
Biometría Hemática (Control)
Leucocitos: 6,780 /uL 4,000–10,000 /uL
Neutrólos: 41% 40%–75%
Linfocitos: 39% 20%–45%
Hemoglobina: 11.7 g/dL 11.5–15.5 g/dL
Hematocrito: 33.8% 34%–44%
Plaquetas: 447,000 /mm³ 150,000–450,000 /mm³
PCR: 3.69 mg/Dl < 5 mg/dL
Hemocultivo Sin crecimiento -
Cultivo de Orina Sin crecimiento -
Estudios de Tuberculosis No reactivos -
Hisopados para VSR y PCR CO-
VID Negativos -
Hisopado para Inuenza Tipo I Positivo -
Ecocardiograma Normal, sin derrame peri-
cárdico -
Cultivo de Catéter Sin crecimiento bacteriano -
Gram de Catéter Sin crecimiento -
Biopsia
Exudado brino leucocita-
rio, sin granulomas ni mi-
croorganismos patógenos
-
Fuente: Elaboradas por el autor
1.1 Figures, Tables and Diagrams
Table 1.
Auxiliary examinations performed on the patient
Laboratory Tests Results Reference Value
Blood Count Leukocytes: 22,800 /uL 4,000 - 10,000 /uL
Neutrophils: 76.1% 40% - 75%
Lymphocytes: 12.3% 20% - 45%
Hemoglobin: 8.4 g/dL 11.5 - 15.5 g/dL
Hematocrit: 24.2% 34% - 44%
Platelets: 750,000 /mm³ 150,000 - 450,000 /mm³
CRP: 268 mg/dL < 5 mg/dL
PCT: 1.13 mg/dL < 0.5 mg/dL
Blood Count (Control) Leukocytes: 6,780 /uL 4,000 - 10,000 /uL
Neutrophils: 41% 40% - 75%
Lymphocytes: 39% 20% - 45%
Hemoglobin: 11.7 g/dL 11.5 - 15.5 g/dL
Hematocrit: 33.8% 34% - 44%
Platelets: 447,000 /mm³ 150,000 - 450,000 /mm³
PCR: 3.69 mg/Dl < 5 mg/dL
Blood Culture No growth -
Urine Culture No growth -
Tuberculosis Studies Non-reactive -
Swabs for RSV and COVID PCR Negatives -
Swab for Inuenza Type I Positive -
Echocardiogram Normal, without pericardial effusion -
Catheter Culture No bacterial growth -
Catheter Gram No growth -
Biopsy Leukocyte brin exudate, without granulo-
mas or pathogenic microorganisms -
Source: Prepared by the author
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Pneumonia Complicated by Lung Abscess and Pleural Effusion.
Case Report and Review of the Literature
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Figure 1. Chest X-ray with condensation image in the left hemithorax,
area of alveolar inltrate with blurring of the left costodiaphragmatic and
cardiophrenic angle
Figure 2. Lung window computed tomography showing a left lower lobe
lung abscess with a thick-walled cavity and air-uid level.
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Case Report and Review of the Literature
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Figure 3. Computed tomography in the pulmonary window showing a left
pleural effusion, evidenced by the accumulation of uid in the pleural
space, partially displacing the pulmonary structures.
3. Discussion
The case presented describes a 5-year-old male patient with a
complex clinical presentation including complicated pneumonia, pleural
effusion, and lung abscess. This type of presentation is relatively common
in pediatrics, especially in children with a history of previous respiratory
infections. According to a recent study, respiratory infections are a leading
cause of morbidity and mortality in children, and complicated pneumonia
can result in hospitalization and intensive treatment [5].
The patient’s clinical history, which includes high fever, cough,
and shortness of breath, is indicative of a severe respiratory infection
requiring immediate medical attention. The progression of symptoms
from a dry cough to a wet cough, accompanied by vomiting and high fever,
is a pattern that may indicate progression of the disease to complicated
pneumonia [6]. Identication of symptoms such as tachypnea and
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Case Report and Review of the Literature
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shortness of breath are criteria for severity that warrant hospitalization
and intensive management [7].
The patient had an incomplete vaccination schedule for his age, with
a valid vaccination card showing that he was still due for chickenpox (15
months) and DPT at 18 months (rst booster), which is a negative aspect in
his medical history. Vaccination is essential to prevent severe infections, as
it reduces the incidence of pathogens such as Streptococcus pneumoniae
and Haemophilus inuenzae, which are common germs that cause
pneumonia in this age group [8]. However, his previous hospitalization
for respiratory failure suggests an underlying vulnerability to respiratory
infections. It is important to note that, although vaccination decreases
the risk of pneumonia, it does not completely eliminate it, especially in
children with underlying conditions.
The decision was made to hospitalize the patient due to his symptoms,
which presented a high risk of decompensation. Considering the clinical
features, risk factors, and laboratory results, such as leukocytosis and
elevated CRP, which are markers of inammation and infection, it was
decided to initiate empirical antimicrobial therapy due to the suspicion
of involvement of the most common bacterial infectious agents in our
community, such as Streptococcus pneumoniae, Staphylococcus aureus,
and Haemophilus inuenzae. Leukocytosis and elevated acute-phase
reactants are common indicators of bacterial infection and support
the decision to initiate antibiotic treatment. The CT report conrmed
the presence of complications associated with pneumonia, such as
lung abscesses, which can arise in the context of an untreated or poorly
managed infection. These complications, together with the time of disease
progression, justify the urgent need for appropriate antibiotic treatment
to prevent further deterioration in the patient’s health. Furthermore, it
has been documented that viral infections can predispose to bacterial
superinfections, which is increasingly common in clinical practice [9].
Chest X-ray and CT conrmed the presence of a lung abscess and pleural
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Case Report and Review of the Literature
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uid, justifying subsequent surgical intervention, considering that these
abscesses can develop between 1 to 3 weeks after a lung infection [10].
Video-assisted thoracoscopy and subsequent lobectomy are justied
procedures in cases of complicated lung abscesses, especially when there
is signicant involvement of the lung parenchyma. Surgical intervention
is often necessary to drain abscesses and improve pulmonary ventilation
[11]. Fibrin removal and pleural uid management are crucial to prevent
further complications and improve respiratory function, especially in
cases where the lung abscess is large (usually larger than 5 cm), presents
signicant clinical symptoms such as respiratory distress, persistent
fever or productive cough with purulent sputum, or does not respond to
adequate medical treatment after 48–72 hours. Furthermore, drainage
is indicated in the presence of signicant pleural effusion or empyema,
as well as in patients with comorbid conditions that may complicate
recovery. The Wood-Downes scale modied by Ferrés is an essential
clinical tool to assess the severity of respiratory distress in pediatric
patients with complicated pneumonia. This scale considers parameters
such as respiratory rate, accessory muscle use, tachypnea, cyanosis, and
abnormal breath sounds, allowing the classication of symptom severity
and guiding rapid therapeutic decisions. The application of this scale
would be crucial in determining the need for more intensive interventions,
such as respiratory support or surgery. Evaluation with this scale helps
tailor clinical management and guide decisions regarding antimicrobial
treatment and possible surgical interventions, ensuring appropriate care.
[12]. Radiological evaluation showing an abscess that does not resolve
with medical treatment also warrants intervention, and consultation
with pediatric surgery or pulmonology specialists is recommended to
determine the most appropriate drainage method. [13].
The administered antibiotic treatment, which included ceftriaxone
and vancomycin, is adequate to cover a wide range of pathogens,
including those commonly associated with complicated respiratory tract
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infections. This regimen is justied by the presence of germs frequently
detected in different age groups, such as Streptococcus pneumoniae and
Staphylococcus aureus (including methicillin-resistant strains - MRSA),
and that is why this regimen was chosen, since these pathogens are
relevant in the pediatric population and can contribute to the severity of
infections. [14]. The treatment duration of 21 days is consistent with the
guidelines for the management of complicated pneumonias in pediatrics,
reinforcing the importance of an aggressive approach in the treatment of
these infections. Although shorter courses may be appropriate in certain
situations, in the context of complicated pneumonias, conventional
therapy remains the preferred option to ensure complete eradication and
prevent complications [15].
It is essential to emphasize the importance of not self-medicating, as
this can hamper bacterial isolation in cultures and complicate infection
management [16]. Patient progress to a hemodynamically stable state
without respiratory distress at discharge is a positive indicator of treatment
effectiveness. Normalization of hematologic parameters and absence
of bacterial growth in cultures are also encouraging signs suggesting
resolution of the infection.
4. Conclusions
This case highlights the complexity of managing complicated
pneumonia in children, where early identication and appropriate
treatment are essential to improve outcomes. Furthermore, vaccination
against Streptococcus pneumoniae is crucial to prevent pneumonia and
other related infections in children under 5 years of age. In Ecuador,
the implementation of the pneumococcal conjugate vaccine (PCV10) in
2011 and the use of PCV13 in the private sector since 2010 have improved
coverage against the most common serotypes. PCV10 protects against
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33.3% of the serotypes identied in this population, while PCV13 covers
66.6%, highlighting its superior efcacy compared to local epidemiology.
However, the emergence of serotypes such as 19A and 15A, which are not
included in PCV10, indicates the need to adjust vaccination strategies for
better prevention. It is crucial to continue monitoring the predominant
serotypes through epidemiological reports such as those from SIREVA
II, which will allow for the adaptation of immunization policies and
strengthen the protection of children in Ecuador. This will provide
a protective factor in preventing severe respiratory infections in the
pediatric population.
5. Abbreviations
WHO: World Health Organization
DP: Pleural Drainage
PCR: C-reactive protein
DPT: Diphtheria, Pertussis, and Tetanus
KG: Kilograms
IV: Intravenous
DNA: Deoxyribonucleic Acid
TB: Tuberculosis
ATB: Antibiotics
LDH: Lactate Dehydrogenase
AF: High Flow
FIO2: Fraction of Inspired Oxygen
PEWS: Pediatric Early Warning Score
RSV: Respiratory Syncytial Virus
PCV10: 10-Valent Pneumococcal Conjugate Vaccine
PCV13: 13-Valent Pneumococcal Conjugate Vaccine
SIREVA II: Bacterial Resistance Surveillance System
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6. Contribution of the authors
First author initials: Data collection, case description, literature and
analysis.
Second author initials: Systematic review and case discussion
Third author initials: Final case review and updated literature
contribution
Fourth author initials: Initial corrections, gures and tables
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Case Report and Review of the Literature
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