Pyopneumothorax secondary to Streptococcus milleri infection

Successful Interventional Treatment of Pyopneumothorax Caused by Streptococcus constellatus Associated with Hashimoto's Thyroiditis: A Case Report and Literature Review

Background

Streptococcus constellatus rarely causes pyopneumothorax, which is a serious state and requires a surgery. However, not every patient can tolerate surgery and individualized solutions are needed. Furthermore, many known situations are risk factors of S. constellatus infection, but S. constellatus pyopneumothorax associated with Hashimoto's thyroiditis has not been reported.

Case Presentation

We present the case of a 74-year-old male with multiple encapsulated pyopneumothorax caused by S. constellatus. Given his respiratory failure, we provided two-stage percutaneous right empyema radiography for catheter drainage in the radiology interventional department instead of surgery. Moreover, an occult Hashimoto's thyroiditis was discovered in the patient, which was possibly associated with S. constellatus pyopneumothorax. Levothyroxine was administered to improve his situation.

Conclusion

To our knowledge, it is the first case described in this context. We provided an alternative treatment for S. constellatus encapsulated pyopneumothorax in patient who might not tolerate surgery. We also revealed the possible relationship between S. constellatus pyopneumothorax and Hashimoto's thyroiditis.

Hydropneumothorax as a complication of necrotizing pneumonia

Introduction

Hydropneumothorax with a bronchopleural fistula is an infrequent but severe complication of necrotizing pneumonia associated with high morbidity and mortality. Few cases in the adult population have been reported.

Case report

This is a case of a 76-year-old male patient who developed pneumonia caused by Pseudomonas aeruginosa and Klebsiella pneumoniae complicated by hydropneumothorax. He was managed conservatively with chest tube placement but denied surgical management and eventually died despite initial improvement.

Conclusions

Early recognition and appropriate management of pneumonia complications, such as hydropneumothorax, including thoracic surgeon interventions, are crucial as this complication can be fatal. Factors like the patient's overall status, preferences, and comorbidities may have a crucial effect on clinical decisions and outcomes.

Afebrile tension pyopneumothorax due to anaerobic bacteria: Fistula or gas production?

Pyopneumothorax is characterized by a pleural collection of pus and air requiring emergent thoracic drainage. A 65-year-old diabetic woman presented with a two-week history of fatigue and dyspnea but without fever. Chest computed tomography showed extensive pleural effusion and air in the left pleural cavity, which caused a mediastinal shift with peripheral circulatory failure. There was no evidence of a pulmonary fistula. Anaerobic bacteria were found in the pus smear after microscopy. After 17 days of chest drainage and 18 days of antibiotic treatment, the patient recovered without any complications. The etiology of pyopneumothorax in this case was slowly progressive pyothorax due to gas-producing anaerobic bacteria. In conclusion, we should pay careful attention to serious infectious diseases, including pyothorax, in diabetic patients due to the high prevalence and subclinical symptoms.

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Pyopneumothorax is characterized by a pleural collection of pus and air.

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Tension pyopneumothorax presents as dyspnea and fever progressing within several days.

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The patient developed afebrile tension pyopneumothorax over the course of 4 weeks.

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Gas-production by anaerobic bacteria can cause tension pyopneumothorax of the patient.

Successful treatment of pyopneumothorax secondary to Streptococcus constellatus infection with linezolid: a case report and review of the literature

Background

Pyopneumothorax secondary to Streptococcus constellatus infection is a clinically rare event, and few cases have been reported.

Case presentation

We report the case of a 55-year-old Han Chinese man with underlying diabetes who presented with fever of 17 days duration. A pulmonary computed tomography scan revealed right-sided massive pyopneumothorax. A culture of the pleural effusion and blood grew S. constellatus. A drug sensitivity test showed that the isolate was sensitive to linezolid, penicillin G, cefotaxime, vancomycin, and cefuroxime. Our patient was treated with linezolid for a total of 6 weeks. Subsequently, his chest computed tomography scan showed improved lung condition.

Conclusion

To the best of our knowledge, this is the first case of pyopneumothorax secondary to S. constellatus to be treated with linezolid. Pyopneumothorax may be caused by streptococcal infection, and linezolid is another good choice for treatment.

Streptococcus constellatus Causing Empyema and Sepsis, Necessitating Early Surgical Decortication

Streptococcus constellatus is an oropharyngeal commensal Gram-positive coccus, frequently associated with the respiratory tract. S. constellatus is part of the Streptococcus anginosus or milleri group, which has traditionally been considered to have propensity to cause empyema and purulent abscesses, a property that is sometimes overlooked as the severity of infections it causes may have a varying degree. In this case, we present the case of a 54-year-old male with known liver cirrhosis who developed a severe empyema during an acute liver failure episode, requiring extensive decortication and prolonged hospital admission.

Rapidly progressive necrotizing pneumonia: remember the Streptococcus anginosus group!

Acute necrotizing pneumonia in an immunocompetent host is uncommon and usually caused by Staphylococcus aureus infection. Streptococcus anginosus group (SAG) is a less recognized cause of rapidly destructive lung infection resulting in significant patient morbidity and mortality. Unlike many other bacterial infections, SAG can cross fascial planes and cause fulminant infections. Necrotizing pneumonia and lung abscesses due to SAG often fails conservative therapy with antimicrobials and requires definitive surgical intervention. Consideration of SAG as a potential etiology might help to institute definitive therapy earlier and prevent complications.