Community-Acquired Pneumonia

Domachowske, Joseph; Suryadevara, Manika

A 9-year-old previously healthy, fully immunized female is seen in the pediatrician’s office for a 3 day history of fevers to 102 °F, cough, and right-sided abdominal pain. On examination, she has a temperature of 38.6 °C, heart rate of 120 beats per minute, respiratory rate of 20 breaths per minute, and oxygen saturations of 94% on room air. She is mildly ill-appearing, with crackles over the right lung base noted on auscultation. The remainder of her exam is benign. She is clinically diagnosed with right lower lobe community-acquired pneumonia (CAP). A 10-day course of oral amoxicillin is prescribed. Two days later, she is seen in the emergency department for persistent fevers, now up to 104 °F, worsening dyspnea, chest pain, abdominal pain, and vomiting. A chest x-ray at this time reveals a right lower lobe pneumonia with a large pleural effusion. She is admitted to the hospital for management of complicated CAP and treated with intravenous ampicillin. The pleural fluid is drained and sent to the microbiology lab for diagnostic evaluation. PCR of the pleural fluid is positive for Streptococcus pneumoniae, the most common cause of bacterial CAP. She continues receiving intravenous ampicillin during her hospital stay. By day 5, she has been afebrile for over 24 hours, tolerating oral intake, and has no supplemental oxygen requirement. She is discharged home to complete a course of oral amoxicillin for treatment of complicated CAP.