Lung abscess in a young patient.

To cite: Fernandes AM, Pedreira DG, Janeiro S, et al. BMJ Case Rep Published online: [please include Day Month Year] doi:10.1136/ bcr-2013-202761 DESCRIPTION A 21-year-old man with no clinically relevant medical history presented to the emergency room with a 3-week history of cough and fever. He had already been evaluated by his family practice physician who prescribed a 3-day course of azithromycin. The patient reported mild improvement of symptoms that lasted about 2 weeks. Four days before the admission he again reported to his doctor with recrudescence of symptoms. He was prescribed a new course of antibiotics with a different macrolide (clarithromycin). The patient’s cough showed no improvement and he again reported with fever (maximal temperature 39°C) that did not improve with antipyretics. At admission, observation showed fever (tympanic temperature of 38.6°C) with chills. He had intense cough without sputum and showed no signs of respiratory distress. Pulmonary auscultation revealed rude murmur on both hemithoraces. The laboratory results revealed an elevated C reactive protein of 11.78 mg/dL and leukocytosis of 14 800/μL. A posteroanterior chest X-ray showed a round-shaped cavity containing an airfluid level, with adjacent consolidation (figure 1). A CT scan of the chest confirmed the presence of consolidation in the inferior left lobe consistent with pneumonia that had complicated with lung abscess (figure 2). Given that lung abscess are usually due to aspiration, the patient was asked about episodes of loss of consciousness, like seizures or alcohol abuse, which he denied. His HIV test was negative and no history of tuberculosis contact was determined. Blood cultures drawn at admission were sterile probably due to prior antibiotic therapy. He was given an 8-day course of piperacillin/tazobactam