case_images: PMC6174774_01
case_images: (a) Chest X-ray and (b) chest computed tomography scan of the thoracic region. The images indicate a large pleural empyema of a right pulmonary lesion.
case_images: CRIPE2018-4509847.001.jpg
case_images: PMC6174774_01_CRIPE2018-4509847.001.jpg
case_images: fig1
case_images: A chest X-ray and chest computed tomography revealed consolidation and a large-right pleural effusion (Figures 1(a) and 1(b)).
case_images: Clinical course of the patient. IL-1beta, IL-6, IL-10, and TNF-alpha were elevated 1 week after the influenza infection but normalized as the symptoms improved. GAS, Streptococcus pyogenes; PSL, prednisolone; sIL-2R, soluble interleukin-2 receptor; ASO, antistreptolysin O antibody; WBC, white blood cell counts; CRP; C-reactive protein, CTRX, ceftriaxone; ABPC, ampicillin; CLDM, clindamycin; IVIG, immunoglobulin; and VATS, video-assisted thoracoscopic surgery.
case_images: CRIPE2018-4509847.002.jpg
case_images: PMC6174774_01_CRIPE2018-4509847.002.jpg
case_images: fig2
case_images: The clinical course of the patient is shown in Figure 2.
case_images: (a) Aspirated pus from the pleural empyema. (b) Operative thoracoscopic views obtained from video-assisted thoracoscopic surgery. White arrows indicate severe adhesion by fibrin between the parietal pleura (X) and the pulmonary pleura (Y).
case_images: CRIPE2018-4509847.003.jpg
case_images: PMC6174774_01_CRIPE2018-4509847.003.jpg
case_images: fig3
case_images: The aspirated pleural fluid was serological with a yellowish brown color and pH of 7.002, WBC of 33,900/microL, protein of 4.7 g/dL, LDH of 9,121 U/L, and adenosine deaminase of 173.7 U/L (Figure 3(a)). Thoracoscopy of the thoracic cavity revealed an adhered pulmonary and parietal pleura with fibrin; the cavity was then peeled off and washed using saline (Figure 3(b)).