Avraham Zvi Cooper*, Jennifer Sawaya and Jared Grochowsky
Avraham Zvi Cooper, Medical Resident, Beth Israel Deaconess Medical Center,, Internal medicine, USA
Received date: March 29, 2015; Accepted date: April 15, 2015; Published date: April 20, 2015
Citation: Cooper AZ, Sawaya J, Grochowsky J (2015) Into the Abscess: A 50 Year-Old Man with Empyema Necessitans. J Pulm Respir Med 5:i017. doi:10.4172/2161-105X.1000i017
Copyright: © 2015 Cooper AZ. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
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A 50-year-old man presented with two months of malaise, weight loss, and back pain after an accidental aspiration. Labs showed a neutrophilic leukocytosis of 23,000/uL. Imaging revealed a large pleural and paraspinal fluid collection (Figures 1-3), extending down to the pelvis, consistent with empyema necessitans and paraspinal
abscess. Cultures grew Streptococcus anginosus (also known as Strep. milleri). He received antibiotics and drainage, with course complicated by malnutrition, tracheostomy, and encephalopathy. His care was eventually transitioned to comfort-focused. Commonly causing brain and abdominal abscesses, S. anginosus uncommonly causes empyema, usually from aspiration . It produces hyaluronidase, allowing for liquefaction of and extensive spread through tissues .