Necrotizing Pneumonia: A Case Report on a Rare Complication of Respiratory Syncytial Virus Pneumonia

Abstract

Background: Necrotizing pneumonia is uncommon in children compared to adults. It is characterized by progressive pneumonic illness in a previously well child despite appropriate antibiotic treatment. This further leads to areas of necrosis and liquefaction of the consolidated lung tissue, which may be complicated by solitary, multiple, or multiloculated radiolucent foci, bronchopleural fistulas, and intrapulmonary abscess formation. Necrotizing pneumonia is usually secondary to Pneumococcus, Staphylococcus aureus, or, less commonly, Pseudomonas aeruginosa infections, and is rarely seen secondary to viruses. Although cavitary necrosis manifests as a severe disease, most children exhibit complete  recovery even without surgical treatment and have normal chest radiographs in the long term.
Case report: In this report, a 3-year-old immunocompetent patient developed pleural effusion and empyema and underwent ultrasound-guided  drainage without clinical improvement, leading to necrotizing pneumonia secondary to a respiratory syncytial virus and requiring video-assisted  thoracoscopic surgery. We initiated conservative treatment with prolonged antibiotics, ventilator support, and analgesics.
Conclusion: Early surgical intervention in cases of necrotizing pneumonia is challenging, and it is unknown whether it is superior to medical management. Repeating chest radiographs should be considered in cases of changes in the patient’s status or whenever there is a delay in recovery.