A case of round pneumonia due to Enterobacter hormaechei: the need for a standardized diagnosis and treatment approach in adults

• Published in: Revista do Instituto de Medicina Tropical de São Paulo Vol. 63; pp. e3 - 5
• Main Authors: Jiménez-Castillo, Raúl Alberto, Aguilar-Rivera, Leonardo René, Carrizales-Sepúlveda, Edgar Francisco, Gómez-Quiroz, Ricardo Andrés, Llantada-López, Anabella Rosalía, González-Aguirre, Julio Edgardo, Náñez-Terreros, Homero, Rendón-Ramírez, Erick Joel
• Format: Journal Article
• Language: English; Portuguese
• Published: Brazil Instituto de Medicina Tropical de Sao Paulo 01.01.2021; Instituto de Medicina Tropical; Instituto de Medicina Tropical de São Paulo; Universidade de São Paulo (USP)
• Subjects: Adult; Adults; Aged; Anti-Bacterial Agents - therapeutic use; Antibiotics; Antimicrobial agents; Case Report; Cough; Dyspnea; Emergency medical care; Enterobacter - isolation & purification; Enterobacter hormaechei; Enterobacteriaceae Infections - diagnosis; Enterobacteriaceae Infections - drug therapy; Fever; Humans; Levofloxacin - therapeutic use; Liver cirrhosis; Lung - diagnostic imaging; Male; Medical diagnosis; Medical imaging; Pathogens; Pneumonia; Pneumonia - diagnosis; Pneumonia - microbiology; Respiratory failure; Round pneumonia; Sepsis; Sputum - microbiology; Streptococcus infections; Treatment Outcome; TROPICAL MEDICINE; Enterobacter hormaechei; Adults; Round pneumonia; Liver cirrhosis
• ISSN: 1678-9946; 0036-4665; 1678-9946
• DOI: 10.1590/s1678-9946202163003

Round pneumonia is an unusual radiological manifestation of a bacterial lung infection. We present the case of an elderly male patient who arrived at the emergency room with a productive cough and exertional dyspnea. His chest x-ray and CT showed a round opacity and air bronchograms in the right upper lobe. Taken together, the patient's symptoms and images strongly suggest a pulmonary infection. Empirical antibiotic therapy with ceftriaxone and clarithromycin was started. The sputum culture was positive for Enterobacter hormaechei and the bacterium was sensitive to levofloxacin; therefore, the antibiotic therapy was changed. Despite the treatment, the patient progressed to respiratory failure and septic shock, dying six days after admission. Although round pneumonia is uncommon, it is a potentially curable disease and clinicians should always consider it in their differential diagnosis.