Multiple Pulmonary Bacterial Abscesses

A 21-year-old woman with human immunodeficiency virus infection and a CD4 count of 400 cells per cubic millimeter who was not receiving antiretroviral therapy presented with a 1-week history of fever, chest pain, and hemoptysis. She reported having used illicit intravenous drugs in the past.

Physical examination revealed a 3/6 pansystolic murmur over the cardiac apex and the left lower sternal border and coarse rhonchi in bilateral lung fields.

A chest radiograph revealed bilateral multiple cavitary lesions with air–liquid levels. Computed tomography confirmed the presence of several rounded, radiolucent lesions with air–liquid levels and well-defined margins — findings that were consistent with the presence of multiple pulmonary abscesses.

Multiple Pulmonary Bacterial Abscesses on CXR and CT
Multiple Pulmonary Bacterial Abscesses on CXR and CT

Echocardiography showed a fluttering vegetation, 0.8 by 2.2 cm, on the tricuspid valve, with moderate tricuspid regurgitation. Blood cultures yielded methicillin-susceptible Staphylococcus aureus.

Septic thrombophlebitis and right-sided endocarditis are important causes of multiple pulmonary bacterial abscesses. The patient was treated with intravenous oxacillin for 6 weeks. At the 3-month follow-up visit, she was doing well, and chest radiography showed that the lung abscesses had resolved.