What happened, in summary

A 51-year-old man with a history of smoking and chronic obstructive pulmonary disease had been diagnosed 10 months earlier with locally advanced non-small-cell lung cancer in the lower-left lobe. His cancer had been described as stable before he was referred to the emergency department with severe shortness of breath and low oxygen levels.

On arrival he was in respiratory distress, with difficulty speaking, noisy breathing and chest retractions. His condition deteriorated rapidly, with worsening mental status and marked hypercapnia. Blood tests showed a white-cell count of 24.9 and a C-reactive protein level of 270 mg/L. CT imaging revealed a pulmonary abscess, consolidation of the entire lower-left lobe and pulmonary artery involvement by the cancer.

He received intravenous antibiotics and respiratory support and was intubated. He then developed atrial flutter followed by a 10-minute cardiopulmonary arrest and was transferred to intensive care. A few hours later, massive hemoptysis led to hypovolemic shock and another cardiopulmonary arrest.

He died during the admission, 5 days after presenting to the emergency department. Microbiological analysis later identified Oligella urethralis from a protected bronchial sample. His final course reflected the combined burden of severe lung infection, respiratory failure and underlying lung cancer.