amoxicillin-potassium-clavulanate-combination and Pulmonary-Embolism

We report an unusual presentation of pulmonary embolism (PE) where a 58-year-old man first developed symptoms of community-acquired pneumonia. Despite antibiotic therapy, he remained unwell with rising inflammatory markers, general malaise and persistent cough. He developed stony dull percussion and absent breath sounds to his left mid to lower zones. Serial chest x-rays showed progression from lobar consolidation to a large loculated left-sided pleural collection. CT chest showed left-sided lung abscess, empyema and bronchopleural fistulation. Incidentally, the scan revealed acute left-sided PE and its distribution corresponded with the location of the left lung abscess and empyema. The sequence of events likely started with PE leading to infarction, cavitation, abscess formation and bronchopleural fistulation. This patient was managed with a 6-month course of rivaroxaban. After completing 2 weeks of intravenous meropenem, he was converted to 4-week course of oral co-amoxiclav and metronidazole and attained full recovery.

Topics: Abscess; Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Bronchial Fistula; Disease Progression; Drug Therapy, Combination; Humans; Infarction; Male; Meropenem; Metronidazole; Middle Aged; Pleural Diseases; Pneumonia; Pulmonary Embolism; Radiography, Thoracic; Rivaroxaban; Thienamycins; Treatment Outcome

Human-to-human transmission of Fusobacterium necrophorum has not been described before.. We present the case of a 15-year-old girl with Lemierre Syndrome and possible nosocomial transmission of F. necrophorum to her treating physician in hospital.. Early diagnosis and treatment of anaerobic pharyngitis is critical to prevent Lemierre Syndrome. Respiratory precautions should be recommended to medical staff caring for patients with suspected Lemierre Syndrome to prevent nosocomial transmission.

Topics: Adolescent; Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Cross Infection; Drug Therapy, Combination; Early Diagnosis; Female; Fusobacterium Infections; Fusobacterium necrophorum; Humans; Image Processing, Computer-Assisted; Infectious Disease Transmission, Patient-to-Professional; Internship and Residency; Jugular Veins; Lemierre Syndrome; Pediatrics; Pneumonia, Bacterial; Pulmonary Embolism; Shock, Septic; Tomography, X-Ray Computed; Tonsillitis