Surgical Decortication in Paediatric Necrotizing Pneumonia: A Case Report

Abstract

Necrotizing pneumonia is an uncommon but severe complication of paediatric pneumonia and may be associated with pleural empyema, lung collapse, consolidation, and persistent fever despite antimicrobial therapy. This case report describes a 5-year-old girl who presented with fever and cough for 10 days. She had previously been diagnosed with right lung consolidation and pleural effusion and had received antibiotic therapy, including vancomycin. On examination, she was conscious and alert, with a pulse rate of 112 beats/min, respiratory rate of 28 breaths/min, and oxygen saturation of 98% on room air. Respiratory examination revealed reduced air entry and dullness over multiple regions of the right hemithorax. Anthropometric assessment showed a weight of 13.6 kg, height of 116 cm, and body mass index of 10.2 kg/m². Contrast-enhanced computed tomography of the thorax demonstrated right-sided pleural empyema, lung collapse and consolidation, mediastinal lymphadenopathy, and mild hepatomegaly, consistent with complicated pneumonia. Because of persistent infection and pleural collection, the child underwent video-assisted thoracoscopic surgery with decortication and intercostal drain insertion under general anaesthesia. She received intravenous vancomycin and ceftriaxone, antipyretics, and supportive care. The patient showed gradual clinical and radiological improvement and was discharged in satisfactory condition. This case highlights the importance of early recognition, appropriate imaging, and timely surgical management in selected paediatric patients with complicated necrotizing pneumonia.