Conservative Therapy with Intrapleural Urokinase Avoids Primary Thoracotomy in Childhood Necrotizing Pneumonia: A Case Series

Introduction: Necrotizing pneumonia is a rare complication of community-acquired pneumonia. Lung resection is gaining attention as therapeutic alternative in patients who fail to respond to antibiotics. However, we aimed to describe two cases of childhood necrotizing pneumonia successfully managed conservatively. Case Report: MA, a 2-year old boy presented with acute onset respiratory distress with 5 days history of fever and cough. Computed tomography (CT) thorax revealed right pleural effusion with features of necrotizing pneumonia. Despite chest drainage and two weeks of broad-spectrum antibiotic therapy, there was no clinical improvement. Intrapleural urokinase instillation resulted in clinical and radiological improvement. Our second case was NR, an 8-month old girl who presented with acute onset breathing difficulty. CT thorax reported severe left lower lobe necrotizing pneumonia with left hydro-pneumothorax. Ultrasound of left thorax showed presence of left pleural effusion despite nil chest drainage. She improved clinically and radiologically following intrapleural urokinase administration over three days. Conclusion: Intrapleural urokinase may prevent the need of thoracotomy or video-assisted thoracoscopic surgery in necrotizing pneumonia.