Case Report: Necrotizing pulmonary destruction and fatal gangrene: the imperative of early recognition

Pulmonary gangrene is a catastrophic end-stage manifestation of necrotizing pulmonary infection, often arising on the basis of unrecognized and chronically survived pulmonary thromboembolism. Large-vessel thrombosis leads to ischemia and infarction of pulmonary parenchyma, creating an ideal substrate for secondary infection with subsequent rapid tissue devitalization. Impaired perfusion prevents adequate antibiotic delivery, facilitating explosive progression of necrosis.

We report a fatal case of pulmonary gangrene in a 59-year-old man with a history of chronic alcohol abuse and prior gastric resection due to ulcer disease. Initial imaging demonstrated bilateral cavitations, while clinical deterioration despite broad-spectrum antimicrobial therapy revealed complete destruction of the left lower lobe, hydropneumothorax, and pulmonary embolism. Autopsy confirmed pulmonary gangrene, pulmonary infarction, and bilateral pyothorax.

This case highlights the importance of recognizing pulmonary infarction secondary to thromboembolism as a fertile ground for fulminant infectious destruction.