A case of septic pulmonary embolism caused by urinary tract infection

Abstract

A 56-year-old woman with diabetes mellitus (DM) presented at our department with intermittent low-grade fever, right-side back pain and general fatigue, having taken antibiotics (cefotiam) for the preceding two weeks as prescribed at another healthcare facility. Despite the absence of any cough or sputum production, chest X-ray revealed multiple nodular lesions in the peripheral lung fi elds (Figure-1). These nodules were not observed at the time of initial treatment at the referring hospital. Chest CT indicated multiple nodules with necrotic centers in the peripheral bilateral lung fi elds (Figure-2). Abdominal CT showed a swollen right kidney and diffuse abscesses (Figure-3). A diagnosis of septic pulmonary embolism accompanied by pyelonephrosis was made. Accordingly, an alternative antibiotic (cefotaxime) was administered against sepsis. The multiple nodules in the lung and the diffuse renal abscesses simultaneously disappeared within two months after this course of highly potent anti-bacterial therapy. DM control was also accomplished by insulin therapy.Septic pulmonary embolism has been defi ned as a lung embolism caused by a blood clot infected with any of several bacterial or fungal species. Typically, patients present with high-grade fever, productive cough, general malaise and hemoptysis. The presence of DM has an unfavorable impact on disease progression and prognosis. The most common radiographic fi ndings are bilateral peripheral nodules with feeding vessels and cavity formations less than 3 cm in diameter (1). Septic pulmonary emboli are classifi ed according to their source, i.e.