11th January 2024

An 89-year-old gentleman has been in hospital for the last 7 days being treated for a severe community-acquired pneumonia.

An 89-year-old gentleman has been in hospital for the last 7 days being treated for a severe community-acquired pneumonia. Despite 7 days of intravenous antibiotics, he continues to spike regular temperatures, so a chest x-ray is completed, which shows a right-sided pleural effusion with associated right middle zone consolidation. A diagnostic aspiration is completed. 

Investigations: 

Pleural fluid pH 6.95

Pleural fluid protein 43g/L 

Pleural fluid LDH 1342 units/L 

Pleural fluid M, C + S: Neutrophilia, Pseudomonas aeruginosa. 

Given the underlying diagnosis, what underlying pathophysiological mechanism has led to its development? 

Select the SINGLE most appropriate option from the list below. Select ONE option only.