EC Clinical and Medical Case Reports

Necrotizing pneumonia (NP) is a rare complication of infectious pneumonia, requiring early diagnosis and multidisciplinary medical and surgical management to improve the immediate and long-term prognosis of patients.

Our work is a descriptive study conducted on 30 cases of necrotizing pneumonia, collected in the Pneumo-Allergology and Pediatric Infectiology Department of the Children's Hospital in Rabat between 2021 and 2024. The aim is to analyze the clinical, biological, and radiological characteristics of necrotizing pneumonia in children. The mean age of the patients was 6 years, with 16 boys and 14 girls, and had no significant medical history (70% of cases). No immunodeficiency or vaccination delays were reported. The mean time between the onset of symptoms and hospitalization was 20 days. A total of 76.6% of our patients received antibiotic therapy, and 73.3% received non-steroidal anti-inflammatory drugs before hospitalization.

At admission, the primary symptoms included fever, cough, dyspnea, hemoptysis, and abdominal pain; respiratory distress and persistent fever were the main reasons for hospitalization. The diagnosis of necrotizing pneumonia was confirmed through computed tomography, which showed pulmonary consolidations predominantly on the right side, as well as pleural effusion in 11 patients.

Laboratory analyses revealed inflammatory anemia in 83.3% of cases, neutrophilic leukocytosis in 80%, and elevated C-reactive protein (CRP) in 93.3% of cases, with a mean level of 182.4 mg/L. Blood cultures isolated a pathogen (Staphylococcus aureus) in only one instance, while two cytobacteriological examinations of sputum yielded positive results for S. aureus and Pseudomonas aeruginosa. No pathogens were identified in pleural fluid cultures.

All patients received intravenous antibiotic therapy, primarily with cephalothin, transitioning to oral antibiotics to complete a total treatment duration of 6 to 8 weeks. In certain cases, second-line therapy (vancomycin, ceftazidime, cefotaxime) was required. Pleural drainage was performed in 5 patients, pneumothorax drainage in 4, and thoracoscopy in 3 children.

Most patients had a favorable outcome. However, nine patients developed complications: one pneumothorax (13.3%), one septic shock with endocarditis and pulmonary embolism (3.3%), and one empyema (13.3%). One death was reported. The average hospital stay was four weeks. A six-month follow-up showed complete resolution of pulmonary and pleural lesions in all patients.

 Keywords: Necrotizing Pneumonia; Child; Antibiotic; Drainage

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