SAQ 99 – Infectious Disease – febrile neutropenia with abnormal chest X-ray

Question 5. febrile neutropenia with abnormal chest X-ray.

a. Chest X-ray abnormalities

• Near-complete opacification of the left lung field.
• Surgical clips in the right neck.
• Surgical clips in the right axilla.
• Asymmetric breast shadow.
• Mediastinal shift to the right.
• Patchy changes in the right lung.

b. Antibiotics

• Piperacillin-tazobactam IV, or cefepime IV, or ceftazidime IV as anti-pseudomonal beta-lactam cover.
• Add vancomycin if line infection, MRSA, severe sepsis, septic shock, or local risk factors are present.

c. Justification

• Febrile neutropenia requires urgent broad-spectrum antibiotics with Pseudomonas cover.
• A vascular access device may be the source of sepsis, so vancomycin is reasonable when catheter-related infection or MRSA risk is suspected.

d. ED investigations

• Peripheral blood cultures.
• Blood cultures from the central line or port.
• Sputum microscopy, culture, and sensitivity if productive.
• Calcium.
• ECG.
• Bedside transthoracic echocardiography if endocarditis or line infection is suspected.
• Swab any skin lesion or line-site abnormality.