Background:Lung abscess is a severe pulmonary infection characterized by localized suppuration and necrosis of
lung parenchyma, often associated with high morbidity and mortality. Klebsiella pneumoniae is a frequent causative
pathogen, especially in immunocompromised patients.
Objectives:To present a case of lung abscess caused by Extended-Spectrum Beta-Lactamase (ESBL) producing
Klebsiella pneumoniae in a patient with dual immunosuppression due to HIV infection and uncontrolled diabetes
mellitus, and to highlight the clinical challenges in its management.
Results:A 58-year-old male with HIV infection on regular antiretroviral therapy and uncontrolled type 2 diabetes
mellitus presented with shortness of breath, productive cough, and fever. Radiological examination revealed a large
cavitary lesion with an air-fluid level in the left hemithorax, accompanied by empyema and pneumothorax. Chest
tube drainage yielded 1500 mL of purulent fluid. Microbiological culture identified ESBL Klebsiella pneumoniae.
The patient was initially treated with intravenous levofloxacin and metronidazole, later switched to moxifloxacin
based on antibiotic sensitivity, leading to significant clinical improvement.
Conclusion:This case emphasizes the complexity of managing lung abscess in immunocompromised patients with
uncontrolled comorbidities. Risk factors such as large cavity formation, empyema, multidrug-resistant pathogens,
and poor metabolic control contribute to poor prognosis. Effective management requires adequate drainage, cultureguided antibiotic therapy, and control of underlying conditions. Prolonged antibiotic therapy with close radiological and clinical follow-up is recommended to optimize outcomes and prevent recurrence.
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