Lung abscess rather than pneumatocele following kerosene ingestion

Abstract

A 5-year-old Malay boy was admitted to the authors' hospital for accidental kerosene oil ingestion with possible aspiration. He accidentally ingested kerosene oil which had been kept in a mineral water bottle but the amount ingested was not known. He then had several episodes of vomiting and subsequently became tachypnoeic. There was no history of seizures. On physical examination, he was conscious but tachypnoeic with a respiratory rate of 50 per minute. There was a smell of kerosene from his mouth. He was afebrile and other vital signs were normal. His oxygen saturation ranged from 97% to 99%. Respiratory system examination did not show other abnormalities. Examination of other systems was unremarkable. His chest radiograph on admission (Figure 1) showed no abnormal findings. He was observed in the ward and managed conservatively. He became more tachypnoeic and developed a high grade fever of about 39°C 12 hours after admission. His repeated chest radiograph (Figure 2) suggested pneumonitis of the left lung. Intravenous cefuroxime was instituted. He showed clinical improvement and was asymptomatic 1 week later. However, a chest radiograph taken before discharge (Figure 3) showed a thick wall cavity approximately 3 × 2.5 cm in size with evidence of air–fluid level in the left lower lobe. Computed tomography of the thorax (Figure 4) showed that only one cavity was present. This was presumed to be a partially treated lung abscess and intravenous ceftriaxone was commenced. He completed 2 weeks of intravenous ceftriaxone and a further 2 weeks of oral cefuroxime. He responded well to the antibiotics and a chest radiograph taken on follow up about 5 months later showed the cavity in the left lower lobe had completely resolved.