8 Months Prior
61-year-old – male presented with 3-week cough productive of phlegm and blood, right-sided chest pain, and 20-lb weight loss over the past 4 months
CXR showed consolidative opacity in R upper lobe with two intrinsic air fluid levels concerning for abscess.
CT chest showed right middle lobe abscess, and smaller consolidation in the anterior segment of right lower lobe concerning for multifocal airspace disease.
Pt was started on IV Unasyn q6h, and pulmonology was consulted.
TB was ruled out with 2 PCRs and 2 smears.
Sputum culture showed 1+ gram negative rods, and 1+ gram positive cocci in pairs.
MRSA PCR was negative.
Per Pulmonology, continued IV Unasyn , then switched to Augmentin po.
Pt improved clinically, was feeling better,
Pt presented with productive cough, hemoptysis, R sided pleuritic chest pain, fever, tachycardia on admission. CT chest showed R middle lobe abscess. Differential included aspiration, given pt’s history of alcohol use disorder, and TB given pt’s prior homelessness and incarceration, and malignancy given pt’s recent 20 lb weight loss.
TB PCR x2 was negative and sputum culture showed 1+ gram negative rods, and 1+ gram positive cocci in pairs. Fever has come down and pt is feeling better since starting Unasyn. Per pulmonology recommendations, continued Unasyn IV fthen transitioned to po Augmentin. Will follow-up CT chest in 6 weeks.
1 Month Later
6 Months Later