10year boy from Medinipur, West Bengal who presented with a 14-day history of fever , cough and right lung upper lobe consolidation on chest Xray. He was treated for 14days at native place but there was no improvement noted. After we received the patient, lung ultrasound showed dense consolidation of lung lobe with pleural effusion. Pleural fluid tapping was performed twice over span of four days. Pleural fluid culture had ESBL-producing Klebsiella. Given the poor drug penetration in long-standing lung consolidation, we followed the “hit hard” principle in antibiotic therapy. Unfortunately, the child developed a right pneumothorax during respiratory secretion clearance, which was promptly managed with an intercostal drain (ICD). After 10 days of IV antibiotics, the chest X-ray at discharge showed well-demarcated borders of the right upper lobe marking improvement both clinically and radiologically.
August 28, 2025
