25326              ACUTE HAEMORRHAGIC BRONCHOPNEUMONIA (KLEBSIELLA INFECTION)

The patient was a man aged 36 who was admitted with severe respiratory failure necessitating positive pressure ventilation.  He then developed renal failure and wad dialysed, and also cardiac failure attributed to cardiomyopathy.  Blood cultures were positive for mycoplasma, to a titre of 1/80 rising in 2 weeks to 1/320.  The renal failure responded but cardiac failure persisted, with bradycardia and arrythmia, and he died on the 10th day.  At postmortem there was blood in the bowel, petechial haemorrhages in the skin and cultures of the blood and organs grew klebsiella and pseudomonas.

The specimen is the left lung sectioned to show antemortem thrombus in medium-sized vessels in the lower lobe.  There are areas of irregular infarction in the anterior basal segment of the lower lobe and the lingular segment of the upper lobe.  Some of these areas are breaking down from incipient abscess formation.  There are small clusters of miliary bronchopneumonic consolidations in the posterior segment of the lower lobe and in the hilar region of the upper lobe.  Histology shows acute septic pneumonia, with vascular thrombosis, infarction and abscess formation.  Large masses of organisms are present in the necrotic areas.  The surrounding lung shows some interstitial thickening of alveolar walls.