CRITICAL ROLE OF CHEST TUBE DRAINAGE AS THE INITIAL TREATMENT FOR KLEBSIELLA PNEUMONIAE-RELATED PYOPNEUMOTHORAX: A CHALLENGING CASE REPORT FROM MOHAMMAD NOER GENERAL HOSPITAL, PAMEKASAN

Introduction:Pyopneumothorax caused by Klebsiella pneumoniae infection is a clinically rare event, and few cases have been reported. Chest tube drainage insertion is crucial due to potentially large and prolonged air leaks, and increased risk of morbidity and mortality.

Case presentation: An Indonesian male, 40 years old with underlying diabetes mellitus who presented with 1 month of progressively worsening shortness of breath (SOB), chest discomfort, cough, nausea and fever. The patient appears weak, dyspnea, blood pressure (BP) of 120/80 mmHg, heart rate (HR) of 161 bpm, respiratory rate (RR) of 32 x/min, oxygen saturation (SpO2) of 84% room air. On inspection and fremitus, the development of left lung expansion was delayed. Percussion sound of left lung was dull on the first day hospitalization but reverse to hypersonor on the fifth day of hospitalization and rhonchi of the right lung on auscultation. Laboratory examination showed leukocyte was elevated to 18.040/Cmm. A chest X-ray on the first day hospitalization revealed pneumonia of dextra lung and pleural effusion of left hemithorax. On the day fifth of hopitalization, chest X-ray revealed pneumothorax sinistra. A culture of the sputum and pleural effusion grew Klebsiella pneumoniae. The patient underwent needle thoracocentesis with chest tube drainage and antibiotic therapy for 7 days. The patient had improved but a few days later developed a pneumothorax sinistra. Based on persistence of fever and not restoring lung expansion, the patient referred to another hospital that had better facilities.