클렙시엘라 폐렴의 합병증으로 발생한 광범위 폐괴저

• Published in: Tuberculosis and respiratory diseases Vol. 57; no. 4; pp. 381 - 385
• Main Authors: 하준욱, 엄광석, 장승훈, 반준우, 김동규, 정기석, Ha, Jun-Wook, Eom, Kwang-Seok, Jang, Seung Hun, Bahn, Joon-Woo, Kim, Dong-Gyu, Jung, Ki-Suck
• Format: Journal Article
• Language: Korean
• Published: 대한결핵및호흡기학회 01.10.2004
• Subjects: 내과학; Klebsiella; Pulmonary Gangrene
• ISSN: 1738-3536; 2005-6184

Pulmonary gangrene is a rare and severe complication of bacterial pneumonia, where a pulmonary segment or lobe is sloughed due to parenchymal devitalization of the parenchyma, with secondary anaerobic infection and necrosis caused by pulmonary vascular thrombosis. Prior to the antibiotic era, massive pulmonary gangrene was potentially fatal. Herein, a case of pulmonary gangrene in a 67-year-old man is reported. He complained of fever, chills, dyspnea and purulent sputum of 5 days duration. The plain chest radiograph showed well-marginated right upper lobe consolidation, with bulging minor fissure, suggestive of a Klebsiella infection. A contrast CT scan demonstrated consolidation of the right upper lobe, with a central necrotizing portion. Klebsiella species was confirmed from both sputum and blood cultures. After appropriate antibiotics, the chest X-ray and CT scan 3 weeks later showed a large cavity with an air-fluid level, sloughing-off and extrusion of necrotic lung tissue, suggestive of pulmonary gangrene. Seven months later, the right gangrenous lung showed severe volume loss on a chest radiograph. The management of pulmonary gangrene has been somewhat controversial. Herein, it was managed without surgical drainage or resection. If the antibiotic therapy had failed, then a surgical approach would have been considered. 저자들은 클렙시엘라균종에 의한 폐렴에 동반된 폐 괴저를 수술적 치료없이 약물로만 호전시킨 1예를 경험하였기에 문헌고찰과 함께 보고하는 바이다.