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Sputum culture taken at her admission&#44; viral serologies &#40;HIV&#44; HBV&#44; etc&#46;&#41; and atypical bacterias study were negative&#46; She received high dose of intravenous amoxicillin&#8211;clavulanate &#40;2<span class="elsevierStyleHsp" style=""></span>g every 8<span class="elsevierStyleHsp" style=""></span>h for two weeks&#41; and then changed to oral &#40;maintaining same dose&#41;&#44; completing 6 weeks of treatment&#46; She also received respiratory physiotherapy during admission and at home&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">The patient had a favorable clinical and radiological evolution and blood test became normal&#46; Because of the excellent response to conservative treatment&#44; we decided not to do bronchoscopy&#44; balancing risk&#8211;benefits&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">New thoracic computed tomography scan was done 4 months later&#44; which showed consolidation and cavities resolution and residual fibrosis-atelectasis&#46; Lung function tests were normal&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">D&#46; pneumosintes</span> is an anaerobic&#44; gram-negative&#44; non-lactose-fermenting rod&#44; belonging to normal bacterial flora of the oral cavity&#44; pharynx&#44; intestine&#44; and vagina&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">1</span></a> It usually provokes soft tissue abscess or maxillofacial and periodontal infections&#46;<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">1&#44;2</span></a> Nevertheless&#44; its pulmonary infection is extremely rare&#44; although there are some cases reported of mechanic-ventilated patients&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">3</span></a> There are no necrotizing pneumonia in an immunocompetent patient due to <span class="elsevierStyleItalic">D&#46; pneumosintes</span> reported&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">Necrotizing pneumonia is a severe and rare lung infection&#44; 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Case Report
Necrotizing Pneumonia Due to Dialister Pneumosintes
Javier Romero Lópeza,
Corresponding author
javiromlop7@gmail.com

Corresponding author.
, Juan José Maya Gonzálezb, Roberto del Pozo Rivasa
a Pneumology Service at Juan Ramón Jiménez Hospital, Huelva, Spain
b Radiodiagnosis at Juan Ramón Jiménez Hospital, Huelva, Spain
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Chest ultrasounds were done&#44; dismissing pleural effusion&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">Since blood tests and X-rays were altered&#44; a computed tomography &#40;CT&#41; pulmonary angiogram was performed &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41; to rule out pulmonary thromboembolism&#46; Instead&#44; an extensive consolidation that occupies the entire left lower lobe with two cavitations inside with air-fluid level was found&#44; the largest one of 7<span class="elsevierStyleHsp" style=""></span>cm&#46; These findings suggested necrotizing pneumonia with lung abscesses &#40;A and B&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">Microbiological examination for blood was positive for <span class="elsevierStyleItalic">Dialister pneumosintes</span>&#44; even though she had neither personal history of oral infection nor dental manipulation&#46; Sputum culture taken at her admission&#44; viral serologies &#40;HIV&#44; HBV&#44; etc&#46;&#41; and atypical bacterias study were negative&#46; She received high dose of intravenous amoxicillin&#8211;clavulanate &#40;2<span class="elsevierStyleHsp" style=""></span>g every 8<span class="elsevierStyleHsp" style=""></span>h for two weeks&#41; and then changed to oral &#40;maintaining same dose&#41;&#44; completing 6 weeks of treatment&#46; She also received respiratory physiotherapy during admission and at home&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">The patient had a favorable clinical and radiological evolution and blood test became normal&#46; Because of the excellent response to conservative treatment&#44; we decided not to do bronchoscopy&#44; balancing risk&#8211;benefits&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">New thoracic computed tomography scan was done 4 months later&#44; which showed consolidation and cavities resolution and residual fibrosis-atelectasis&#46; Lung function tests were normal&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">D&#46; pneumosintes</span> is an anaerobic&#44; gram-negative&#44; non-lactose-fermenting rod&#44; belonging to normal bacterial flora of the oral cavity&#44; pharynx&#44; intestine&#44; and vagina&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">1</span></a> It usually provokes soft tissue abscess or maxillofacial and periodontal infections&#46;<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">1&#44;2</span></a> Nevertheless&#44; its pulmonary infection is extremely rare&#44; although there are some cases reported of mechanic-ventilated patients&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">3</span></a> There are no necrotizing pneumonia in an immunocompetent patient due to <span class="elsevierStyleItalic">D&#46; pneumosintes</span> reported&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">Necrotizing pneumonia is a severe and rare lung infection&#44; which typical radiologic manifestation is as a gas-filled space within pulmonary consolidation&#44; a mass&#44; or a nodule&#46;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">4</span></a> Usually&#44; it has a subacute presentation&#44; with wet and smelly cough&#44; fever&#44; and dyspnea&#46;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">5</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">Its initial treatment is empiric antimicrobial therapy for oropharyngeal flora&#44; being amoxicillin&#8211;clavulanate at high doses the elected antibiotic&#44; to get into the cavitations&#46; There is no agreement in the length of the treatment&#59; however&#44; at least should last from 4 to 8 weeks &#40;the first 10&#8211;15 days parenterally&#41;&#44; as we treated our patient&#46; When conservative treatment does not work&#44; it may be necessary CT-guided percutaneous drainage&#44; and in rare occasions surgery is needed&#46;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">5</span></a></p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflict of interests</span><p id="par0050" class="elsevierStylePara elsevierViewall">The authors state that they have no conflict of interests&#46;</p></span></span>"
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