Severe haemoptysis in a child with anaerobic pneumonia

Abstract

Introduction Anaerobic chest infection in paediatric population is unusual and it may cause necrotizing pneumonia leading to severe complications. We describe the clinical course of an immunocompetent child suffering from Prevotella necrotising lobar pneumonia, further complicated by severe haemoptysis. Case description A five year-old boy presented with persistent right upper lobe (RUL) consolidation on chest radiograph over 3 months, was previously managed as community acquired pneumonia with standard courses of beta-lactam and macrolide antibiotics. Computerised Tomography (CT) thorax showed features of RUL necrotising pneumonia and bronchoscopic bronchoalveolar lavage yielded heavy growth of an anaerobic organism, the Prevotella species. He had severe dental caries with multiple rotten teeth suspected to be contributing to the anaerobic infection. He was managed with metronidazole for two weeks plus a prolonged course of amoxicillin/clavulanic acid for four weeks with clinical response. About one week after completion of antibiotics, he was re-admitted for severe acute haemoptysis requiring intubation and blood transfusion. Bronchoscopy demonstrated bleeding from RUL corresponding to the findings of CT angiogram that confirmed abnormal vasculature within the cavitating lesion. Bleeding gradually settled after cold saline bronchial lavage and was extubated in three days followed by occasional mild haemoptysis. Extensive search for other microbiological causes was not revealing. Subsequently, right upper lobectomy was performed at about six weeks later with histopathological diagnosis of necrotizing bronchiolitis. This case illustrates the importance of multidisciplinary management for complex respiratory infections in children.