Slow-resolving pneumonia, case report

Respiratory infections are one of the main causes of consultation and hospitalization in primary health care, including pneumonia. We present the case of a 3-year-old preschooler who came to the health services for presenting frequent wet cough and fever of up to 39 degrees Celsius of 8 days of evolution, who was previously treated with oral Amoxacillin in his health area without resolution of the symptoms. On physical examination, the patient was found to be in good general condition, where only the presence of crackling rales in the right lung base was positive; antimicrobial therapy was started, showing clinical improvement and cessation of the febrile symptoms. On the fifth day of evolution the febrile symptoms reappeared with peaks of up to 39 degrees Celsius. Physical and radiological examination showed worsening of the symptoms. Results of nasopharyngeal exudate were received, which showed Klebsiella pneumophila. An evolutionary chest X-ray was indicated, resulting in a denser and more homogeneous opacity with radiolucent areolar images towards its upper contour that kept occupied upper and middle segments of the right lung field, showing a phase of hepatization of the process with images suggestive of pneumatoceles. Antimicrobial spectrum was extended with Meropenen associated to Vancomycin according to antibiogram and possible sensitivity according to the most frequent etiology according to age, with satisfactory resolution of the picture. Atypical etiologies, including Klebsiella pneumophila, should be suspected in the case of slowly resolving pneumonia.