Job's syndrome presenting with a tension pneumothorax and a lung abscess
نویسندگان
چکیده
A 19-year-old male presented to the emergency department with severe hypoxic respiratory distress. He had a history of hyperimmunoglobulin E syndrome (HIES) diagnosed at the age of 24 months. He had recurrent skin abscesses with Staphylococcus aureus and multiple respiratory infections with S. aureus and Pseudomonas aeruginosa. He had also developed bronchiectasis and required left lower lobe lobectomy in early childhood. Chest X-ray (CXR) revealed a right tension pneumothorax with a large lung abscess (Fig. 1). A chest tube was placed (Fig. 2) and empiric antibiotics were initiated. The patient refused any further intervention for the abscess and the pneumatocele. The chest tube drained purulent-appearing material that suggested a possible ruptured pulmonary abscess into the pleural space. The sputum and fluid culture grew Klebsiella oxytoca and Enterobacter gergoviae. A repeat chest tomography a week later revealed resolution of the pneumothorax with improvement of the lung abscess and infiltration (Fig. 3). After a 2-week treatment with intravenous antibiotics, he
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