Staphylococcus aureus necrotizing pneumonia

Case contributed by Alejandro Planas Callao
Diagnosis almost certain


Progressive dyspnea, cough and abundant mucopurulent expectoration. Oral thrush and suspected Candida esophagitis.

Patient Data

Age: 40 years
Gender: Male

On admission


Bilateral upper lobe predominant opacities with large central lucencies.

On admission


Bilateral upper lobe consolidation and crazy paving pattern with large cavities indicating extensive parenchymal destruction. Numerous small cavitating nodules in every lobe with mild peripheral ground glass opacity. Bronchial plugging in the lung bases.

7 months later


Residual bilateral upper lobe lucencies.

9 months later


Right upper lobe cavity with internal dependent fluid and intra-cavitary body. Left upper lobe thin-walled cavity. Upper lobe fibrosis with bronchiectasis and volume loss. Few bilateral and peripheral broncho-centric ground-glass nodules.

Case Discussion

This patient was hospitalized due to the 3-week history of pneumonia on a background of progressive weight loss, anorexia, chronic diarrhea, oral thrush and dysphagia with suspicion of Candida esophagitis.

HIV infection was confirmed - probable stage C3. CD4 levels were 24 cells/mL and the viral load was 196,000 copies/mL. A diagnosis of AIDS-defining illness was established: Candida esophagitis and wasting syndrome based on the clinical manifestations and the presence of analytical markers of severe malnutrition.

In this case, CT findings indicated necrotizing pneumonia, with bacterial being the most likely etiology.

Mycobacterium tuberculosis infection was ruled out by multiple cultures and PCR tests. No microorganisms were isolated from respiratory secretions.

Multiple positive blood cultures for Staphylococcus aureus were obtained. Several trans-thoracic echocardiograms were performed to rule out endocarditis.

The pneumonia responded well to antibiotics and the wasting syndrome responded favourably to antiretrovirals.

The final diagnosis was Staphylococcus aureus pneumonia - the most frequent cause of necrotizing pneumonia. On subsequent follow-up, the pneumonia resolved leaving only two large residual cavities.

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