15552              STAPHYLOCOCCAL PNEUMONIA

The patient was a man aged 37, known to be diabetic for 8 years.  Initially this was treated with insulin but latterly by oral agents.  He was a heavy drinker.  He was admitted after a fit and then developed what seems to have been delirium tremens.  Later he was found in diabetic ketosis with sweating, rapid pulse and breathlessness and a fever of 104oF.  A few days later a friction rub was heard at the left base posteriorly.  He became cyanosed and died after an episode of severe respiratory distress, clinically considered to be due to pulmonary oedema.  At postmortem a large fatty liver was found and there was bilateral consolidation in the lower lung lobes from which a coagulase positive staphylococcus was grown.  The liver was small and cirrhotic.

The specimen is a slice of the left lung.  There is massive confluent septic bronchopneumonic consolidation throughout most of the lower lobe sparing only portion of the anterior basal segment and the hilum.  There is abscess formation in many of the septic foci, producing groups of small cavities a few mms in diameter.  The intervening lung shows grey consolidation.  The lower lobe is somewhat emphysematous and there is a slight increase in interlobar markings, probably indicative of interstitial oedema.  The pleural surface shows large areas of yellow suppuration corresponding to the underlying abscesses.  Much of the pleural surface of the lung is covered by a thick layer of fibrinous pleurisy.  Section shows suppurative pneumonia.