Bronchopleural cutaneous fistula due to <i>Eikenella corrodens</i>

Abstract

Objective: The aim of this paper is to review the subject and to report on and discuss a case of bronchopleural cutaneous fistula due to Eikenella corrodens. Description:A 16-year-old girl was brought to our hospital with fever and blood-tinged sputum 2 weeks prior to her admission. She suffered from neurologic sequelae of herpetic encephalitis and had been bed-ridden since 5 years of age. A longitudinal paraspinal soft mass had been noted in the previous week by her mother. She had been given oral feeding despite frequent choking for the past few years. On palpation, the mass can be squeezed to follow the least resistance of subcutaneous space longitudinally extending to the lower thoracic region. Chest computed tomography scan revealed right lower lobe necrotizing pneumonitis and a pleuro-cutaneous fistula leading to the subcutaneous air locules. A protracted course of antibiotics was prescribed and subcutaneous air trapping decreased in size over 8 weeks.Comments: Eikenella corrodens has increasingly been implicated as a potential causative pathogen in pleuropulmonary infections. Pleuro-cutaneous fistula and abscess formation complicating empyema and necrotizing pneumonitis due to E. corrodens infection have not been reported. A bulging thoracic subcutaneous lesion waxes and wanes with respiration suggest the possibility of a pleruo-cutaneous fistula. Treatment of Eikenella empyema using antibiotics without surgical decortication requires a prolonged course of antibiotic therapy. Descrição: Paciente do sexo feminino, 16 anos de idade, foi encaminhada ao nosso hospital em estado febril com histórico de escarro com estrias de sangue há 2 semanas; apresentava seqüelas neurológicas de encefalite herpética e estava confinada ao leito desde os cinco anos de idade. A mãe da paciente relatou ter detectado, dias antes, uma massa mole paraespinhal longitudinal. A paciente recebia alimentação via oral apesar da ocorrência de freqüentes engasgamentos nos últimos anos. À apalpação, a massa podia ser pressionada até encontrar menor resistência do espaço subcutâneo, estendendo-se longitudinalmente até a região torácica inferior. A tomografia torácica revelou pneumonia necrotizante do lóbulo direito inferior e uma fístula pleurocutânea levando a áreas de cavitação subcutânea. A paciente foi submetida a tratamento prolongado com antibióticos com decrescentes coletas de ar por 8 semanas. J Pediatr (Rio J)Comentários: A Eikenella corrodens tem sido cada vez mais indicada como potencial patógeno causador de infecções pleuropulmonares. Não há relatos de fístula pleurocutânea a formação de abscessos como complicadores de empiema e pneumonia necrotizante causada por infecção de E. corrodens. Presença de lesão torácica proeminente que aumenta e diminui com a respiração pode ser uma indicação de fístula pleurocutânea. O tratamento do empiema de Eikenella com antibióticos sem decorticação cirúrgica exige um tratamento prolongado com antibioticoterapia. J Pediatr (Rio J) IntroduçãoA Eikenella corrodens tem sido implicada como ...

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