 |
Case Report
A case of rapidly progressive empyema caused by Streptococcus anginosus group bacteria in a young male patient
1 Medical student, Frank H. Netter MD School of Medicine, Quinnipiac University, USA
2 Fellow, Department of Infectious Diseases, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
Address correspondence to:
Sarah Wing-Yin Chiu
California, 94403,
USA
Message to Corresponding Author
Article ID: 1000047Z09SC2018
Access full text article on other devices
Access PDF of article on other devices
How to cite this article
Chiu SWY, Zefirova J. A case of rapidly progressive empyema caused by Streptococcus anginosus group bacteria in a young male patient. J Case Rep Images Med 2018;4:1000047Z09SC2018.ABSTRACT
Introduction: The Streptococcus anginosus group bacteria (SAG; formerly Streptococcus milleri) are facultative anaerobes that rarely cause pneumonia but have been increasingly found in empyema. Several reports have suggested that patients with SAG empyema commonly have underlying comorbidities that include diabetes mellitus and malignancy.
Case Report: A 30-year-old male with no past medical history presented with progressive shortness of breath and pleuritic chest pain despite recent treatment with azithromycin. Lung examination was significant for decreased tactile fremitus, decreased breath sounds, and egophony over the left lower lobe. Laboratories demonstrated leukocytosis with marked bandemia. Chest X-ray revealed marked opacification of the left hemithorax and CT chest showed left lung collapse and multiple loculations over the left lower lobe. Intravenous ceftriaxone and clindamycin were initiated, and two left chest tubes drained 2500 ml of pus; however, the patient had intermittent fevers. Thoracotomy was performed on day nine of admission, from which a repeat pleural fluid culture revealed Streptococcus anginosus that was sensitive to penicillin and resistant to clindamycin, erythromycin, and tetracycline. The antibiotic therapy was changed to IV penicillin G, and the patient improved clinically with a resolved leukocytosis.
Conclusion: This was a case of severe empyema in a young male with no underlying medical comorbidity. It is important to conduct appropriate tests to effectively treat the disease as bacteriology changes over time and antibiotic resistance is becoming more prevalent.
Keywords: Antibiotic choice, Empyema, Streptococcus anginosus, Thoracotomy
SUPPORTING INFORMATION
Author Contributions
Sarah Wing-Yin Chiu - Substantial contributions to conception and design, Acquisition of data, Analysis of data, Interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Julia Zefirova - Substantial contributions to conception and design, Acquisition of data, Analysis of data, Interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Guaranter of SubmissionThe corresponding author is the guarantor of submission.
Source of SupportNone
Consent StatementWritten informed consent was unable to be obtained as the patient was lost to follow up. However, the manuscript has been written to include only the necessary information to maintain patient anonymity.
Data AvailabilityAll relevant data are within the paper and its Supporting Information files.
Conflict of InterestAuthors declare no conflict of interest.
Copyright© 2018 Sarah Wing-Yin Chiu et al. This article is distributed under the terms of Creative Commons Attribution License which permits unrestricted use, distribution and reproduction in any medium provided the original author(s) and original publisher are properly credited. Please see the copyright policy on the journal website for more information.
