B71-20 When Alcohol Hits the Lungs: A Fatal Case of Cavitating Pneumonia

Abstract Introduction Alcohol Use Disorder (AUD) is associated with impaired immunity and nutritional deficiencies, among other complications. These factors predispose individuals to severe pulmonary infections and poor outcomes. Cavitating lung lesions complicated by bronchopleural fistulae are rare but carry a high mortality rate. In this case, we discuss cavitating lung lesions with bronchopleural fistula in a patient with AUD. Case Presentation A 39-year-old male, lifetime smoker and with AUD presented with a two-week history of productive cough, generalized weakness, shortness of breath. On examination, breath sounds decreased in the left hemithorax. A chest X-ray revealed a left pneumothorax, and left thoracostomy tube subsequently placed. Computed Tomography (CT) of the chest revealed bilateral cavitating lung lesions with surrounding consolidation, and a left moderate pneumothorax despite the thoracostomy tube in situ, suggestive of a bronchopleural fistula with direct communication to adjacent cavitating lesions. HIV testing was negative. Sputum and pleural fluid cultures grew Acinetobacter species, Klebsiella pneumoniae, Staphylococcus aureus, and Enterobacter species, with no Acid-fast bacilli seen and Polymerase Chain Reaction was negative for Mycobacterium tuberculosis complex. Culture-directed antibiotics were commenced. During admission, the patient’s chest tube had to be replaced multiple times due to poor suture adherence and skin dehiscence. Unfortunately, the patient died on day 24 of admission. Discussion Severe lung infection in individuals with chronic alcohol consumption is multifactorial. This involves impairment of gag and cough reflexes, disruption of mucociliary clearance with overgrowth of pathogenic bacteria, dysfunction of both innate and adaptive immunity- macrophage phagocytic impairment, neutrophil and cytokine dysregulation, leading to defective chemotaxis, and lymphocyte (both T and B cell) dysfunction. Studies have shown that with AUD, smoking further exacerbates alcohol-induced defects. Nutritional deficiencies, such as those involving zinc, vitamins, proteins play a significant role in immune system compromise and poor wound healing. This patient developed bilateral cavitating lung lesions with a bronchopleural fistula with Mixed bacterial infections (Acinetobacter, Klebsiella pneumoniae, Staphylococcus aureus, Enterobacter) suggesting polymicrobial pneumonia. Management was complicated by a persistent pneumothorax despite tube thoracostomy, reflecting an ongoing air leak from the bronchopleural fistula. The patient’s poor nutritional status, impaired wound healing, and immunosuppression likely contributed to the unfavourable outcome. Conclusion This case highlights the severe impact of AUD on pulmonary health and its association with life-threatening infections. Chronic alcohol consumption leads to impaired immune function, poor nutritional status, and decreased tissue repair, all of which contribute to increased susceptibility and poor outcomes in lung infections. This abstract is funded by: none