Patient with recurrent laryngeal-tracheo-bronchial papillomatosis and empyema at necessitatis

Difficulties in diagnosis and management

Abstract

A 17-year-old male patient, with a clinical picture of RRP since18 months of age, who underwent 85 interventions at the laryngo-tracheal level, requiring permanent tracheostomy from the age of 5, presenting recurrent pneumonia with lung papillomatous invasion of right predominance with actinomycete isolation. He developed empyema at neccesitatis from which multiple multiresistant organisms with severe compromise of the pulmonary parenchyma were isolated, which required a right radical pneumonectomy in an attempt to control the infection. He was managed with amphotericin B deoxycholate, meropenem, tigecycline and polymyxin B, despite which he presented worsening of the clinical picture with subsequent refractory septic shock that led to his death