A 27-year-old diabetic male was admitted for fever, impaired consciousness and stiff neck appeared three days after suffering an acute respiratory infection.
She was diagnosed with aseptic meningoencephalitis (CRL of clear appearance, with a pressure of 12 cm H2O; leukocytes: 200/mm3; direct Gram stain and bacterial culture: vancomycin, IV).
Initially he was admitted to an ICU and was on mechanical ventilation, being disconnected after 4 days.
Fever and cough developed one week after onset.
A chest X-ray detected bilateral pulmonary infiltrates.
Three days later, a second X-ray revealed the presence of multiple lung abscesses with air-fluid levels.
Chest CT showed cavitary lesions with gas formation.
Video assisted endoscopy and drainage insertion were performed.
Therapy was then initiated with linezolid (600 mg every 12h iv) and meropenem (1.0 gm every 8h iv), which was maintained for two weeks.
Pleural effusion (purulent aspect, glucose: 40 mg/dL, pH 7.18) gave a culture for P aeruginosa (susceptible to amikacin, gentamicin, ciprofloxacin, cefdime, imipenzi).
There was recovery ad integrum after completion of drainage and antibiotic therapy.
