Multidisciplinary treatment of severe pediatric lung abscess with empyema presenting as abdominal pain: A case report

Background: Pulmonary abscess is a rare but severe suppurative lung infection in the pediatric population. Typical clinical manifestations include fever, cough, productive sputum, and chest pain. The condition is often associated with a prolonged course and high morbidity, and management becomes particularly challenging when complicated by empyema. We report a unique case of pediatric lung abscess presenting with abdominal pain as the initial symptom. The patient exhibited an insidious onset and was successfully treated through a comprehensive strategy involving early thoracoscopic drainage, targeted antibiotic therapy, mechanical ventilation, nutritional support, and pulmonary rehabilitation. No significant sequelae were observed during follow-up. This case highlights the atypical presentation of lung abscess in children and supports the role of multidisciplinary minimally invasive management in complex cases.
Case Report: A 2-year-9-month-old male child presented with abdominal pain as the initial symptom. An abdominal CT scan revealed a large pleural effusion, and the diagnosis was subsequently confirmed by chest CT and pleural fluid analysis. Routine examination of the pleural fluid and metagenomic next- generation sequencing (mNGS) identified the causative pathogen. The patient was diagnosed with sepsis, lung abscess, empyema, and severe pneumonia, indicating a critical condition. A comprehensive, multidisciplinary treatment strategy was implemented: 
1. Antimicrobial therapy: Initial intravenous administration of vancomycin and meropenem;
2. Surgical intervention: Early thoracoscopic drainage, decortication, and closed thoracic drainage;
3. Life support: Mechanical ventilation and nutritional support;
4. Follow-up care: Transition to oral linezolid for sequential therapy, combined with systematic pulmonary rehabilitation. The patient responded favorably to the treatment, achieving a satisfactory outcome with a good prognosis.
Conclusion: Pediatric lung abscess, empyema, and sepsis represent critical illnesses characterized by significant clinical heterogeneity. While prolonged antibiotic therapy remains the cornerstone of treatment for both primary and secondary lung abscesses, this case suggests that early invasive intervention (e.g., thoracoscopic surgery) in selected patients can achieve superior drainage outcomes, reduce the duration of antibiotic therapy and hospitalization, and improve prognosis. Furthermore, a multidisciplinary team approach is of significant value in the management of high-risk pediatric infections.