A 76-year-old male, smoker for 60 years until 2 years ago who stopped smoking, with a history of untreated COPD.
She came to the emergency department with a 48-hour history of general malaise, pleuritic pain on the left side and increased habitual cough and expectoration.
Physical examination revealed a body temperature of 38oC and a diffuse decrease in vesicular murmur with crackles and wheezing in the left lung base.
On admission, 18,600 leukocytes/mm3, 92% neutrophils, and a gas with pCO2 of 27 mm Hg, pO2 56.8, pH 7.48 and HCO3 O2 23.6 showed 92% saturation.
The chest X-ray showed alveolar infiltrates in LII, LSI and cardiomegaly.
We proceeded to the admission of the patient initiating therapy inhaled bronchodilators, administration of low molecular weight heparin at prophylactic doses and antimicrobial treatment with intravenous levofloxacin (500 mg/24 hours).
The clinical picture was slowly tapered, maintaining fever and respiratory failure, and sputum samples for Gram stain and culture were not evaluable, resulting in negative blood cultures.
Therefore, it was decided to perform a fiberoptic bronchoscopy 6 days after admission.
In the bronchial aspirate sample polymorphonuclear abundant Gram staining (> 25 PMN/c x100itic) and Gram-positive bacilli sensitive to cephalopelvic acid and Gram-positive bacteria sensitive to extra- and intracellular ciprofloxacin were observed.
The pathology report confirmed the smear of bronchial exudate as an acute inflammatory process with no evidence of other lesions.
The diagnosis of pneumonia caused by C. pseudodiphteriticum changed the treatment to amoxicillin-clavulanic acid 2 g/ 8 h i.v., with favorable evolution.
