An empyema caused by Streptococcus constellatus in an older immunocompetent patient: Case report. Issue 45 (12th November 2021)

• Record Type: Journal Article
• Authors: Lee, Young Joo; Lee, Jeonghun; Kwon, Byung Su; Kim, Youngsun
• Other Names: Saranathan. Maya section editor.
• Is Part Of: Medicine. Volume 100:Issue 45(2021)
• Publication Date: 2021-11-12
• Subjects: elderly individuals -- empyema -- immunocompetence -- Streptococcus constellatus; Medicine -- Periodicals; Medicine -- Periodicals; Médecine -- Périodiques; Geneeskunde; Medicine; Periodicals; Periodicals; 610.5
• DOI: 10.1097/MD.0000000000027893
• Languages: English
• ISSNs: 0025-7974

Abstract

Abstract: Rationale: Empyema caused by Streptococcus constellatus is rare in patients without underlying diseases. However, the importance of the Streptococcus anginosus group, which consists of S constellatus, S anginosus, and Streptococcus intermedius, as causative organisms of empyema has been increasing. Patient concerns: A 78-year-old man initially presented with dyspnea and chills for 4 days. He had no medical history. Diagnosis: Chest X-ray and chest computed tomography showed a large and multiloculated pleural effusion with an air bubble on the right side. Cultivation of the pleural effusion using clone library analysis of the 16S rRNA gene revealed S constellatus positivity. Interventions: The patient was treated by drainage of the pleural effusion and intravenous ceftriaxone and clindamycin for the possibility of anaerobes, followed by 10 weeks of oral antibiotics. Outcomes: On the 11th day of admission, the thoracic drainage tube was removed. After 1 year of treatment, there were no sequelae of empyema. Lessons: Although S constellatus can cause serious infections in patients with underlying diseases and immunosuppression, physicians need to consider S constellatus infection in community-acquired empyema in elderly individuals. It should be treated with early pleural drainage and antibiotics to avoid surgical decortication and prolonged hospitalization.