A 59-year-old male with a history of stroke with fever per territory of the left middle cerebral artery, with residual sensory-motor aphasia and right hemiparesis, who was taken to the emergency room for a consistent evolution
Physical examination revealed fever of 39°C, pulse 105 bpm, TA 100/60 mmHg and decreased pulmonary murmur in the right hemithorax.
Analytically, he had a blood count of 18,900 leukocytes/mm3 (8% bacilliform), mild anemia with Hb 11.9 g/L (normal 13-15.5 g/L), normocytic and normochromic, and platelets 480,000.
Blood coagulation and biochemistry were normal.
A chest X-ray showed a right submassive pleural effusion.
Abdominal ultrasound showed no significant changes.
Pleural fluid analysis showed a pus-like fluid and pudding odor, biochemically compatible with purulent exudate with a pH of 6.98, glucose 17 mg/dl, LDH 427 mg/dl malignancy (normal LDH 19
Culture was positive for Streptococcus constellatus and anaerobic species (Prevotella intermedia and Fus urealyticus).
Auramine staining in pleural fluid and culture in Löstein's medium were negative.
Blood cultures were also negative.
Treatment was initiated with ceftriaxone (2 g/day) and Clindamycin (600 mg/8h) plus placement of a pleural drainage tube.
Pleural drainage was maintained for 3 weeks and was withdrawn when the output was less than 50 cc daily for 3 consecutive days.
She was treated with antibiotics for 6 weeks and the evolution was slow but progressively favorable, with complete resolution of the empyema at discharge, without the need to use intrapleural fibrinolysis.
After a follow-up of 8 months the patient was asymptomatic and in his basal situation.
The chest X-ray showed no residual pleuropulmonary alterations.
