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A 62-year-old man presented to the emergency department with a 2-day history of dyspnoea and fever. Two weeks prior, he had undergone bilateral bronchial stent insertion for squamous cell carcinoma of the lung, which had been compressing and occluding both main bronchi, more so on the left. The lung cancer had recently been diagnosed and a week prior to presentation the patient had received his first dose of pembrolizumab.
A chest radiograph and subsequent CT chest scan showed multiple new left-sided lung cavities and an ipsilateral hydropneumothorax (figure 1). The CT scan showed the bronchial stents in both main bronchi were patent; however, disease progression of the underlying lung cancer was noted. Intravenous broad-spectrum antibiotics were initiated and a chest drain was inserted, which drained frank pus. Soon after insertion, the chest drain spontaneously migrated out and the patient later developed extensive subcutaneous emphysema. A large bore chest drain was subsequently inserted. Pleural fluid cultures later grew Staphylococcus aureus, Streptococcus anginosus and Streptococcus constellatus and blood …
Footnotes
Contributors CJM and YM were involved in the conceptualisation, data curation, writing, editing and reviewing of the manuscript. HMC and HC contributed to the data curation, analysis, writing, editing and reviewing of the manuscript.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Provenance and peer review Not commissioned; externally peer reviewed.