Untreated Pneumonia Leads to Fatal Outcome

Case Overview

This case takes place in Pennsylvania and involves a male patient who presented to the emergency room complaining of a cold and persistently elevated heart rate associated with nausea and vomiting. The hospital admitted the man, who was observed over the course of several days and prescribed fluids and an over the counter pain medicine for his discomfort. After several days in the hospital, he started complaining of shortness of breath. The patient’s condition continued to deteriorate, at which point he was transferred to the ICU. While in the ICU, it was discovered that the patient had advanced pneumonia. Avelox was used to treat his condition, but the patient’s condition deteriorated further with severe pulmonary edema.

Questions to the Pulmonology expert and their responses

Do you routinely treat patients similar to the one described in the case? Please explain.

As a practicing intensivist and director of the medical ICU, I routinely treat patients with severe pneumonia requiring ICU admission. This patient sounds like he progressed into ARDS, which is a common ICU diagnosis that I am very comfortable treating.

Have you ever had a patient develop the outcome described in the case? If so, please explain.

Yes, severe pneumonias can progress into ARDS (acute respiratory distress syndrome), which has a very high mortality rate. Despite best efforts, patients often succumb to ARDS, which sounds like was the outcome here.

Do you believe this patient may have had a better outcome if the care rendered had been different?

It would depend on the clinical suspicion for pneumonia while she was still in the hospital initially. It sounds like providers thought he had a viral illness and did not prescribe antibiotics at first. Fluids and Tylenol would not have been incorrect management, as her symptoms did seem consistent with a viral illness.

Please tell us why you’re qualified to serve as an expert reviewer of this case.

I am a practicing intensivist and director of the MICU. PNA and ARDS requiring critical care management is a common ICU diagnosis.

About the expert

This 3 time board certified pulmonologist/Critical Care specialist earned her MD at Columbia College and completed post-graduate studies in internal medicine at New York Presbyterian Hospital, went on to complete her fellowship in Pulmonary Critical care at the University of California. She is a member to a number of prestigious societies in her field, including the American College of Chest Physicians and the American Thoracic Society . She is currently the director of Medical Critical Care Services at an University-afiliated Hospital.

E-014159

Specialties:

Pulmonology