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Journal of Case Reports
Conservative Therapy with Intrapleural Urokinase Avoids Primary Thoracotomy in Childhood Necrotizing Pneumonia: A Case Series
Karniza Khalid1, Kean Hong Eng2, Nurul Amani Abd Ghani2, Mohan Arunasalam Nallusamy3
1Clinical Research Centre and 2Department of Paediatrics, Hospital Tuanku Fauziah, Kangar, Perlis, Ministry of Health Malaysia; 3Department of Surgery, Hospital Sultanah Bahiyah, Alor Setar, Kedah, Ministry of Health Malaysia.
Corresponding Author:
Dr. Karniza Khalid
Email: karniza.khalid@moh.gov.my
Received: 20-APR-2019 Accepted: 01-AUG-2019 Published Online: 10-AUG-2019
DOI: http://dx.doi.org/10.17659/01.2019.0043
Introduction: Necrotizing pneumonia is a rare complication of community-acquired pneumonia. Lung resection is gaining attention as therapeutic alternative in patients who fail to respond to antibiotics. However, we aimed to describe two cases of childhood necrotizing pneumonia successfully managed conservatively. Case Report: MA, a 2-year old boy presented with acute onset respiratory distress with 5 days history of fever and cough. Computed tomography (CT) thorax revealed right pleural effusion with features of necrotizing pneumonia. Despite chest drainage and two weeks of broad-spectrum antibiotic therapy, there was no clinical improvement. Intrapleural urokinase instillation resulted in clinical and radiological improvement. Our second case was NR, an 8-month old girl who presented with acute onset breathing difficulty. CT thorax reported severe left lower lobe necrotizing pneumonia with left hydro-pneumothorax. Ultrasound of left thorax showed presence of left pleural effusion despite nil chest drainage. She improved clinically and radiologically following intrapleural urokinase administration over three days. Conclusion: Intrapleural urokinase may prevent the need of thoracotomy or video-assisted thoracoscopic surgery in necrotizing pneumonia. 
Keywords : Drainage, Pneumonia, Respiratory System, Thoracotomy, Urokinase-Type Plasminogen Activator.
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