A 50-year-old man was presented to our hospital (Lishui Municipal Central Hospital, Lishui, China) with cough and sputum that lasted for 2 months and blood-stained sputum that lasted for 1 month. The patient had a history of type II diabetes mellitus and cigarette smoking and no history of hypertension, hepatitis, tuberculosis, or coronary heart disease. The laboratory test results were white blood cell count 9,900 cells/ml (normal range, 4,000-9,500 cells/ml); hemoglobin 144 g/l (normal range, 130-175 g/l); platelets 3,160 cells/ml (normal range, 1,250-3,500 cells/ml) and C-reactive protein 15.6 mg/dl (<8 mg/dl). A chest CT scan (Brilliance iCT; Philips Healthcare, Amsterdam, The Netherlands) revealed a mass in the right lower lung (Figure 1). Based on the history and imaging examination, lung abscess was considered. Antibiotic treatment was used for 2 months. Unfortunately, the mass did not shrink (Figure 2). Antibiotic treatment failed to improve the right pneumonic infiltration. A right lower lobectomy was performed under general anesthesia on August 18, 2020. The chest tube was removed on postoperative day 4. Unfortunately, pneumothorax was presented after the removal of the chest tube (Figure 3). So, a pigtail catheter was inserted for pneumothorax (Figure 4). The pigtail catheter was placed through a guide wire after thoracentesis. As soon as the guide wire was inserted, he presented convulsions, limb stiffness, and unconsciousness. A brain CT scan was performed immediately and showed multiple low densities in the right occipital lobe (Figure 5), which were diagnosed as CAE. Assisted breathing, antibiotic treatment, and antiepileptic therapy were used and the patient gradually improved and was discharged at 27 days of treatment but the muscle strength of the left limb was weakened. At 3 months follow-up, the left muscle strength of the patient had not recovered.
A chest CT scan revealing a mass measuring 3.7 x 3.0 cm in size in the right lower lung (red arrow).