When CAP turns catastrophic: Pediatric necrotizing pneumonia

Abstract

Necrotizing pneumonia (NP) with advanced empyema is a severe complication of pediatric community-acquired pneumonia, increasingly reported even in pneumococcal conjugate vaccine–immunized children. A 3-year-old girl presented with fever, cough, chest pain, and respiratory distress and was found to have CT-proven NP of the left lower lobe with stage IV empyema. She required highflow nasal cannula, broad-spectrum intravenous antibiotics, Video-assisted thoracoscopic surgery (VATS) decortication, prolonged intercostal drainage, and a 4- week parenteral antibiotic course. Despite complete immunization and sterile pleural cultures, respiratory PCR detected Streptococcus pneumoniae. Recent evidence supports early CT imaging, molecular diagnostics, and early VATS for advanced empyema to hasten clinical and radiologic resolution. This case emphasizes guideline-concordant, multidisciplinary management achieving good short-term recovery in complex pediatric NP.