22812              STAPHYLOCOCCAL PNEUMONIA WITH ACUTE ABSCESS FORMATION

This patient was a woman aged 47.  Seven days before her admission to hospital her son-in-law had died from what was said to be viral pneumonia and myocarditis.  She herself had cough, wheezing and fever for 3 days.  On admission her temperature was 40oC, the respiratory rate was 40 and there were widespread signs of consolidation.  A diagnosis of staphylococcal pneumonia was made and treatment with Ampicillin and Methicillin was begun.  Next day Kanamycin and Methicillin were given and she improved a little.  However marked pyrexia remained and X-ray showed air cysts and abscess cavities scattered throughout the lung fields.  About a week after admission it was noted that there was marked weakness and wasting affecting all muscle groups including the face, the respiratory muscles and proximal limb muscles.  Tracheostomy was performed and intermittent positive pressure ventilation was begun.  She later became very drowsy and then unconscious, and remained so until her death 5 weeks after admission.  At postmortem the brain was swollen and there was a recent haemorrhage in the left thalamus and congestion and petechial haemorrhages in the tegmentum of the midbrain and upper pons.  Histology showed softening and demyelination, with haemorrhage and many gitterzellen but there was no obvious evidence of embolic sepsis in the brain. 

The specimen consists of the right lung sectioned to show widespread yellow/grey pneumonic consolidation which is most evident in the lingular segment of the upper lobe and in the apical and posterior basal segments of the lower lobe.  The intervening lung is intensely congested.  Abscess cavities with thin walls are present in the upper lobe.  The largest is a bilocular cavity in the posterior subapical region measuring 4 x 2 x 3 cms.  The walls of these cavities appear remarkably smooth.  Histology shows well organised fibrous tissue in the abscess walls with a thin layer of granulation tissue.