Pranav Kumar*, Somnath Sinha, Ian Migwi and Raymond Chris Aquino
Background: Lung abscess is an uncommon complication in young adults, usually associated with aspiration. Neuromuscular disorders such as Myotonic Dystrophy type 1 (DM1) predispose patients to aspiration due to bulbar weakness, ineffective cough and impaired airway clearance, thereby increasing the risk of necrotising pulmonary infection.
Case presentation: We describe a 25-year-old man with genetically confirmed DM1 who presented with productive cough, intermittent fever, malaise and pleuritic chest pain after a viral upper respiratory tract infection. Imaging revealed a thick-walled cavitary lesion with an air-fluid level in the left lower lobe, consistent with a lung abscess.
Management and outcome: The patient was managed with broad-spectrum intravenous antibiotics, intensive chest physiotherapy and aspiration-prevention strategies. He improved clinically, with resolution of fever within 72 hours and falling inflammatory markers, without requiring invasive drainage or surgical resection. At the time of writing, the patient remains admitted and continues to show progressive inpatient improvement.
Discussion: Aspiration is the leading cause of lung abscess, accounting for more than 80% of cases. DM1 represents a high-risk state due to dysphagia, weak cough and systemic complications. Most cases resolve with antibiotics, although drainage or surgery may be necessary in refractory disease.
Conclusion: This case demonstrates that even during the acute inpatient phase, conservative medical therapy can achieve significant clinical improvement in lung abscess associated with DM1, provided aspiration risk is recognised early and preventive strategies are implemented.
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