CHEST Guidelines-A-28-Year-Old-Pregnant-Woman-With-a-Lung-Abscess-a

A-28-Year-Old-Pregnant-Woman-With-a-Lung-Abscess-a

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A 28-year-old pregnant woman at 22 weeks gestation presented with worsening dyspnea and right-sided pleuritic chest pain, suspecting a bacterial lung abscess and pleural effusion. Initial imaging indicated a cavitary lesion with a pleural effusion, but further diagnostic work, including imaging and laboratory tests, returned negative results for several infectious diseases including TB and Legionella. The pleural fluid analysis suggested an exudative effusion with eosinophilia. Treatment began with antibiotics after a video-assisted thoracoscopy and pleural drainage.<br /><br />Following initial improvement, the patient experienced a setback with recurrent dyspnea due to pneumothorax, treated by another decortication procedure. Pleural fluid cultures then identified Pseudomonas aeruginosa, and the patient was discharged on cefepime. Meanwhile, re-evaluation of the pleural biopsy revealed degenerated protoscolices and hooklets, indicating pulmonary echinococcosis, a type of hydatid disease uncommon in the U.S. but endemic in the patient’s native Sudan.<br /><br />Pulmonary echinococcosis is typically caused by Echinococcus granulosus and can remain asymptomatic for years until a cyst rupture, leading to sudden symptoms like chest pain and dyspnea. Treatment includes surgery, pharmacotherapy, and percutaneous procedures, dependent on cyst location and size. In this case, albendazole was administered safely given the patient's second trimester pregnancy. The patient's symptoms improved with antibiotic and anti-echinococcal treatment, and she later had a normal delivery. Follow-up CT imaging showed resolution of the lung issues.<br /><br />Key points include recognizing echinococcosis in immigrants from endemic areas, understanding that symptoms often arise after cyst rupture, and tailoring treatment to cyst characteristics and patient conditions, particularly concerning the risks of medications during pregnancy.

Keywords

pulmonary echinococcosis

hydatid disease

pregnancy

pleural effusion

dyspnea

pneumothorax

albendazole

Pseudomonas aeruginosa

cyst rupture

Echinococcus granulosus