PMC:7253233 / 4896-6376 JSONTXT

{"target":"https://pubannotation.org/docs/sourcedb/PMC/sourceid/7253233","sourcedb":"PMC","sourceid":"7253233","source_url":"https://www.ncbi.nlm.nih.gov/pmc/7253233","text":"A 76-year-old male with history of chronic asthma on benralizumab, hypertension, chronic kidney disease, hyperlipidemia, left bundle branch block, diastolic dysfunction, and cervical fusion presented to the emergency department with the chief complaint of severe right lower extremity pain, fever (102.5 °F on presentation), and encephalopathy. He was status post recent L3-S1 laminectomy for acute lumbosacral radiculopathy 5 days prior to presentation. Laboratory workup showed neutrophilic leukocytosis (17,200 cells/mm3). He had a Glasgow coma scale of 14, was oriented to name only, and exhibited exaggerated deep tendon reflexes but had no other focal neurological deficits. A computerized tomography (CT) scan of the brain was unremarkable. Magnetic resonance imaging (MRI) of the spine revealed an epidural abscess between L4-S1. Surgical drainage was performed, and the patient was started empirically on vancomycin and piperacillin–tazobactam. Wound cultures grew Pseudomonas aeruginosa. Despite antibiotic therapy, and improved leukocytosis, he continued to have high-grade fevers and acute hypoxemic respiratory failure requiring intensive care unit transfer on postoperative day 1. He was initially managed conservatively with diuresis, preload, and afterload optimization; however, his chest X-ray rapidly progressed to bilateral interstitial and airspace opacification (Fig. 1).\nFig. 1 Chest X-ray showing bilateral lung infiltrates (a) compared to his baseline 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