A 45-year-old woman with a history of type-II diabetes (peroral antidiabetics) underwent surgery for splenic abscess. Splenectomy was performed without any complication. The patient was transferred to the standard ward after surgery. Histology confirmed abscess; however, infected intraparenchymal haematoma could not be excluded. Cultivation revealed Propionibacter avidum (typical skin flora commensal). The patient reported therapy of back pain (3 weeks ago) with the administration of intravenous as well as of paravenous drugs (the only anamnestic source of bacteraemia and splenic abscess respectively). Patient´s history also encompassed suppurative hidradenitis (Propionibacter avidum was also revealed in the axilla) without signs of an exacerbation.
The patient reported worsening dyspnea on day four. CT was performed and revealed a huge pleural effusion with total compression atelectasis of the left lung. Chest drainage was established. Antibiotic therapy already beeing started during surgery was continued (piperacillin + tazobactam). The patient was admitted to our ICU.
Three days later, the chest drain evacuated only a small amount of serous secretion. Antibiotic therapy was finished (on day seven after the surgery). The inflammatory markers persisted high elevated (CRP 400 mg/l, leucocytosis 22 000 with significant neutrophilia and leukemoid reaction, procalcitonin 0.22 ng/dl). Patient´s haemodynamics was stable without the administration of catecholamines. Oxygen therapy was necessary with the use of a normal-flow nasal cannula. No fever was present. Auscultation revealed minimal breathing sounds over the left lung. Examination of the abdomen revealed no pathology.
Lung ultrasonography was performed: