A 75-year-old male, former smoker of 70 packs a year of accumulated consumption, with Mounier-Kuhn syndrome diagnosed approximately 30 years ago, with moderate functional obstruction and chronic home oxygen therapy type 1.
She had a history of chronic pulmonary colonization with Pseudomonas aeruginosa for two years, in treatment with inhaled sodium colistimethate, and several hospitalizations due to exacerbation of her underlying disease.
During hospitalization due to syncope, the patient presented an increase in habitual cough and expectoration, with a change in color and consistency (true purulent) of bronchial secretion, increased breath sounds up to rest and fever auscultation at 38°C.
Laboratory tests: blood count with 12,940 leukocytes/mm3 with 79% neutrophilia.
Arterial gasses with oxygen therapy at 2 L/min: pH 7.4; pCO2 34 mmHg, pO2 59 mmHg, oxygen saturation 91% and bicarbonate 22 mm/l.
Chest radiography showed bilateral reticular interstitial pattern in the lower lobes, probable bronchiectasis and mediastinal widening due to increased caliber of the trachea and main bronchi.
Chest CT showed signs of centrilobular and paraseptal emphysema in the upper lobes with large confluent bullae, dilatation of the trachea and main bronchi, and numerous lobules patches with focal density increase.
Two sputum samples were obtained in successive days at the beginning of the clinical picture, with an acceptable quality of the sample measured by the presence of moderate leukocytes in Gram stain.
Settlement occurred in usual culture media, obtaining abundant growth of A. xylosoxidans colonies.
Identification was performed using semiautomated panels of the Wider system and confirmed in the corresponding reference laboratory.
Susceptibility study revealed carbapenem, piperacillin/ta ciprofloxacin, sensitive cotrimoxazole and gentamicin; resistant to cephalosporins, tobramycin, az-treonam and
Therapy with piperacillin-ta was initiated intravenously (4 g every 8 h) and administered empirically with inhaled bronchodilators, systemic corticosteroids and oxygen therapy.
The patient was admitted with fever and progressive dyspnea and cough.
The expectoration became clearer and fluid and became normal saturation figures with habitual oxygen therapy level at 10 days of antibacterial treatment iv.
1.
She was discharged with oral treatment with cotrimoxazole (800/160 mg every 12 h) for another 12 days.
In subsequent samples, A. xylo-soxidans was not isolated and there was only normal microbiota of the respiratory tract.
