We report the case of a 49-year-old woman with a past medical history of asthma and type 2 diabetes who was admitted to the intensive care unit with diabetic ketoacidosis and bilateral pneumonia due to Klebsiella pneumoniae and required invasive mechanical ventilation. The patient exhibited good initial respiratory progress. However, after 8 days of mechanical ventilation, she developed a spontaneous left pneumothorax, which was drained and the chest drain kept in place. Twenty-four hours later, extubation was attempted, but reintubation was deemed necessary due to weakness and poor secretion management. Following reintubation, the patient exhibited hypotension and acute respiratory failure. A new left pneumothorax was seen, leading to the placement of yet another drainage tube. The thoracic x-ray performed (Fig. 1) revealed the presence of a re-expanded left lung, and a hypodense lesion in the right base and significant subcutaneous emphysema. The CAT scan performed (Fig. 2) with bilateral consolidation confirmed the presence of multiple cavitations consistent with necrotizing pneumonia.
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