Metastatic nodular pneumonia due to septic embolism: a Staphylococcal infection

Advances in internal medicine Pub Date : 2015-12-09 DOI:10.3126/JAIM.V3I2.14068

S. Shrestha, B. Srivastava, R. Khunjeli, Ushab Rana Mousin

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Abstract

Ill-defined lung nodules mimicking secondary metastasis caused by Staphylococcus aureus though defined, is uncommon. We report a 58 years male with chest pain, dry cough, fever and abscess over the nape of neck. Bilateral nodules in the chest x-ray resembled metastasis. Workup for malignancy was negative. Induced sputum grew Staphylococcus aureus resistant to penicillin group. The lesions cavitated and produced air-fluid levels. Computed tomography confirmed the peripheral location, right sided hydropneumothorax and loculated fissural collection. Recovery was favourable but delayed with injectable ceftriaxone and levofloxacin initially followed by oral levofloxacin. Review chest radiograph showed residual cavities with small pneumothorax. Follow-up after three months showed resolution of all cavities and pneumothorax. Literature review revealed both Methicillin sensitive and resistant staphylococcus aureus can cause metastatic nodular pneumonia. Rapidly necrosis occurs if the organisms are capable of producing the toxin: Panton-Valentine Leukocidin. But this tendency is more common with community-acquired methicillin resistant strains. Journal of Advances in Internal Medicine 2014;3(2):68-71

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脓毒性栓塞引起的转移性结节性肺炎:葡萄球菌感染

由金黄色葡萄球菌引起的类似继发性转移的模糊肺结节虽然定义明确，但并不常见。我们报告一个58岁的男性胸痛，干咳，发烧和脓肿在颈背。胸部x线显示双侧结节类似转移。恶性检查为阴性。诱导痰中生长有耐青霉素组金黄色葡萄球菌。病灶空化并产生气液水平。计算机断层扫描证实了外周位置，右侧气胸积液和局部裂缝收集。恢复良好，但最初注射头孢曲松和左氧氟沙星后口服左氧氟沙星延迟。复查胸片显示残余空腔伴小气胸。3个月后随访，所有空腔及气胸均消失。文献回顾显示甲氧西林敏感和耐药金黄色葡萄球菌均可引起转移性结节性肺炎。如果生物体能够产生毒素:潘通-瓦伦丁白细胞杀死素，则会迅速发生坏死。但这种趋势在社区获得性耐甲氧西林菌株中更为常见。内科学进展，2014;3(2):68-71

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Advances in internal medicine

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