Community-acquired pneumonia in a teenager with the first revealed bronchiectasis
Bardenikova S.I.¹, Zaytseva O.V.¹, Snitko S.Yu.¹, Dovgun O.B.<sup>2

1</sup> A. I. Yevdokimov Moscow State University of Medicine and Dentistry
² Children’s City Clinical Hospital of St. Vladimir, Moscow

The article presents a clinical case of bronchiectasis diagnosed for the first time with pneumonia in a boy at the age of 13 years. The severe course of the disease with severe respiratory insufficiency, subcutaneous emphysema, infectious-toxic cardiomyopathy, pulmonary edema, was accompanied by an x-ray picture of multi-focal (multilobar, bilateral) pulmonary lesion and did not correspond to community-acquired infection and the safe premorbid background of the child. Multispiral computed tomography, performed when local symptomatology in the lungs after resolving acute inflammation returned, revealed structural changes in the bronchial tree — cylindrical bronchiectasis. With the resolution of pneumonia, the boy showed a clinical picture of bronchial obstructive syndrome, as a result, probably, of intrahospital superinfection with atypical pathogens (mycoplasmas, pneumocysts) against the background of a decrease in immune resistance. The article notes that the frequent cause of bronchial obstructive syndrome in patients without atopic heredity is atypical infections occurring in the form of obstructive bronchitis. The article discusses the following issues: congenital genesis of multiple bronchiectasis, possible causes of their late verification, the role of the severe course of the present disease with the successive change of infectious agents, algorithms for treating the patient with the importance of active drainage and anti-relapse antibacterial therapy. Issues for discussion are the potential risks of exacerbation of the disease, rational ways of rehabilitation, including active immunization with bacterial pneumococcal vaccines and hemophilic rod, palliative surgical intervention — capable of improving the prognosis of the disease and the quality of life of a teenager with bronchiectatic disease.

Key words: community-acquired pneumonia, pulmonary edema, broncho-obstructive syndrome, superinfection, bronchiectatic disease, rehabilitation, prognosis.
For citation: Bardenikova S.I., Zaytseva O.V., Snitko S.Yu., Dovgun O.B. Community-acquired pneumonia in a teenager with the first revealed bronchiectasis // RMJ. 2018. № 5(II). P.104 –112.