BACKGROUND Enterococci are rarely considered pulmonary pathogens; they are usually regarded as colonizers of the airway. The authors present the case of a previously healthy male adolescent, with complaints of fatigue and chest pain, who was diagnosed with Enterococcus faecalis-associated acute primary lung abscess. CASE PRESENTATION A previously healthy 17-year old boy was admitted to the pediatric ward due to a one-week history of fatigue, inspiratory left side chest pain, dry cough and nasal obstruction. On admission at the emergency department, he was afebrile, with no signs of respiratory distress, but with diminished breath sounds on the left side. A chest x-ray showed a round opacity on the posterior basal segment of the left lower lobe; he was discharged with oral amoxicillin 1000 mg three times a day with the diagnosis of community-acquired pneumonia. Due to the worsening of the productive cough with purulent stinking sputum he was re-evaluated after 4 days. Laboratory studies showed a leukocyte count of 15200/uL and a c-reactive protein of 172 mg/l. The chest computed tomography scan was suggestive of a consolidation of the left lower lobe base and a central abscess. An intravenous course of ceftriaxone and clindamycin was initiated, with a favourable clinical evolution. The bronchofibroscopy performed on day four after his admission revealed the presence of a tracheal bronchus and numerous purulent secretions. Culture examination of bronchoalveolar lavage fluid samples was positive (> 10^5) for Enterococcus faecalis. No complications were registered during his stay in the pediatric ward. He was discharged after a 14-day course of intravenous ceftriaxone and clindamycin, with the recommendation to complete a four-week course of oral amoxicillin/clavulanic acid. On his reevaluation 4 weeks after his discharge, he was asymptomatic. CONCLUSION This case report highlights the importance of considering Enterococcus faecalis as an etiologic agent in cases of non-resolving or complicated cases of pneumonia, such as lung abscesses, even in young patients with no comorbidities or risk factors.

中文翻译：

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男性青少年粪肠球菌相关肺脓肿——病例报告。


背景肠球菌很少被认为是肺部病原体。它们通常被视为气道的殖民者。作者介绍了一名先前健康的男性青少年的病例，主诉疲劳和胸痛，被诊断患有粪肠球菌相关的急性原发性肺脓肿。病例介绍 一名既往健康的 17 岁男孩因一周疲倦、吸气性左侧胸痛、干咳和鼻塞病史入住儿科病房。入院时，他没有发烧，没有呼吸窘迫的迹象，但左侧呼吸音减弱。胸部 X 光检查显示左下叶后基底段有圆形混浊；出院时口服阿莫西林1000毫克，每日3次，诊断为社区获得性肺炎。由于咳痰加重并伴有脓臭痰，4 天后他接受了重新评估。实验室研究显示白细胞计数为 15200/uL，C 反应蛋白为 172 mg/l。胸部计算机断层扫描提示左下叶基底实变和中央脓肿。开始了头孢曲松和克林霉素的静脉注射疗程，并取得了良好的临床进展。入院后第四天进行的支气管纤维镜检查显示存在气管支气管和大量脓性分泌物。支气管肺泡灌洗液样本培养检查粪肠球菌阳性（> 10^5）。在他入住儿科病房期间没有出现任何并发症。在接受 14 天的静脉注射头孢曲松和克林霉素疗程后出院，建议完成为期 4 周的口服阿莫西林/克拉维酸疗程。 出院 4 周后重新评估，他没有任何症状。结论 本病例报告强调了在未解决或复杂的肺炎病例（例如肺脓肿）中考虑粪肠球菌作为病原的重要性，即使对于没有合并症或危险因素的年轻患者也是如此。