Robert J Blue, DO, Jason Kempenich, MD. Keesler Medical Center
Background: Gastroesophageal reflux disease (GERD) is quite common, and its presentation most often includes heartburn and regurgitation. Extraesophageal symptoms such as cough, laryngitis, and asthma have been associated with GERD. Occasional more rare complications, such as pulmonary abscess, have also been noted. Pulmonary abscess is typically a result of aspiration due to reflux of gastric contents. This case is a rare example of a pulmonary abscess caused by GERD.
Case Description: A 70 year-old male presented with a three-day history of chest pain and cough with hemoptysis. He was found to have a leukocytosis and neutrophilia without fevers, chills, or night sweats. His medical history was significant for hypertension, hyperlipidemia, GERD, gout, depression, and excision of multiple squamous cell carcinomas of the skin. He also had a remote smoking history. During initial workup, a pulmonary abscess was discovered and treated with oral antibiotics. The patient failed an initial course of clindamycin, but he was subsequently treated to resolution of symptoms with amoxicillin and clavulanate.
Due to the patient’s self-reported forty-year history of GERD, he continued to have significant sensation of regurgitation, nocturnal cough, and dysphagia. Barium swallow revealed a moderate-sized hiatal hernia and severe spontaneous reflux to the upper thoracic esophagus. With no other etiology of pulmonary abscess revealed after work up, aspiration pneumonia as a complication of GERD was identified as its source. The patient elected to undergo laparoscopic repair of his hiatal hernia with Nissen fundoplication. He recovered appropriately with complete resolution of his symptoms.
Conclusion: Lung abscess is a rare pulmonary complication of GERD. The most common cause of pulmonary abscess is aspiration pneumonia, and conditions such as dysphagia and reflux greatly increase the risk of nocturnal aspiration. Thus, it is surprising that this complication has not been documented more frequently. Further recounting of cases of severe GERD complicated by pulmonary abscess will help characterize patients who are at the greatest risk for this complication.
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