CRA71 PULMONARY EMBOLISM COMPLICATED WITH PULMONARY INFARCTION AND ASSOCIATED WITH PNEUMONIA: A CASE REPORT

Mohd Izzuddin b Subari, Nur Husna Mohd Aminudin, Ng Khai Lip

Hospital Melaka

Background
Pulmonary infarction occurs in approximately one-third of acute pulmonary embolism (PE) cases and may mimic pneumonia due to overlapping clinical and radiological features. When both conditions coexist, diagnosis and treatment become more challenging.

Case Presentation
A 41-year-old male with a history of dyslipidaemia and resolved left-sided hemiparesis from a prior stroke in 2021 presented with five days of fever, cough, and right-sided pleuritic chest pain, along with haemoptysis on the day prior to admission. Chest X-ray revealed right lower zone consolidation with suspected pleural effusion. However, bedside ultrasound did not confirm effusion. A contrast-enhanced CT thorax identified a right main pulmonary artery embolism and pulmonary infarction.

Laboratory tests showed elevated white cell count and CRP. Sputum culture grew Pseudomonas aeruginosa. The patient was treated with a one-week course of antibiotics. Bronchoscopy was non-contributory. Incidentally, clinical and biochemical findings suggested Graves’ disease, and the patient was started on antithyroid therapy. He was also initiated on anticoagulation. His condition gradually improved, and he was discharged in a stable state with follow-up planned for thyroid function and anticoagulation monitoring.

Discussion
This case underscores the difficulty in distinguishing pulmonary infarction from pneumonia, especially when both are present. Imaging, clinical assessment, and microbiological testing are crucial in guiding appropriate management. Early diagnosis and dual treatment are vital to prevent complications such as abscess formation or sepsis.

Conclusion
Though rare, pulmonary infarction complicated by pneumonia can occur, particularly in patients with thromboembolic risk factors. A high index of suspicion and prompt, combined therapy are essential for favorable outcomes.