Unusual Pneumonia Mimic

Authors

• Joana Ricardo Pires Internal Medicine Department, Centro Hospitalar do Baixo Vouga, Aveiro, Portugal
• Maria José Moreira Internal Medicine Department, Centro Hospitalar do Baixo Vouga, Aveiro, Portugal
• Margarida Martins General Surgery Department, Centro Hospitalar do Baixo Vouga, Aveiro, Portugal
• Clarinda Neves Internal Medicine Department, Centro Hospitalar do Baixo Vouga, Aveiro, Portugal

joanaricardopires@gmail.com

Keywords

Abstract

Disease in atypical organ locations can mimic other pathologies, hampering the right diagnosis. Such conditions may even be emergencies, like appendicitis. Subhepatic appendix is a very rare entity which may be caused by caecum dehiscence failure. The authors present the case of a 55-year-old immunocompetent man admitted to the Emergency Department with sepsis and severe hypoxaemia. Chest x-ray showed right lower lobe infiltrate, and community-acquired pneumonia was diagnosed. The patient was started on broad-spectrum antibiotics, but he continued to deteriorate and after 3 days developed abdominal complaints. Exploratory laparoscopy revealed an abscess caused by perforated subhepatic appendicitis.
Subhepatic appendicitis presents a diagnostic challenge and its clinical presentation may mimic that of other entities. This case highlights an atypical presentation, where the early development of inflammatory lung injury mimicked common pneumonia. Maintenance of a high index of suspicion and knowledge of these atypical locations is crucial.