Diagnostic and Therapeutic Approaches to Pediatric Pulmonary Abscess: A Case Report

BACKGROUND Pulmonary abscess is an uncommon complication of pneumonia in pediatric patients. Diagnosis is challenging because early manifestations frequently overlap with those of community-acquired pneumonia. Despite advances in imaging modalities and antimicrobial therapy, pediatric pulmonary abscess remains clinically relevant due to its variable presentation and the difficulty of early identification. This report of pediatric pulmonary abscess highlights clinical features and diagnostic tools that may inform clinical management. CASE REPORT We describe 2 pediatric patients with pulmonary abscess complicating pneumonia. The first was a 4-year-old girl with community-acquired pneumonia who developed a cavitary lesion in the left lower lobe accompanied by empyema, persistent fever, and progressive respiratory compromise despite initial therapy. The second was a 17-month-old boy with right multilobar pneumonia that was complicated by a large right upper lobe abscess and pleural effusion after prolonged febrile illness and multiple evaluations at other hospitals before referral to our institution. In both patients, limited conventional microbiological testing failed to identify a bacterial pathogen, underscoring the diagnostic challenges. Both patients were exclusively treated with intravenous antibiotics followed by oral therapy; surgical and interventional drainage were omitted. Outpatient follow-up at 2 to 6 months confirmed complete clinical recovery and full radiological resolution. CONCLUSIONS These cases emphasize the importance of considering pulmonary abscess as a complication of persistent or worsening pneumonia in children. Early recognition, appropriate imaging, and timely antimicrobial therapy adjustment are essential to prevent complications and support recovery. Individualized follow-up incorporating clinical and radiological assessment ensures complete resolution and appropriate therapeutic response monitoring.