title: Spontaneous bacterial empyema in a noncirrhotic patient: an unusual scenario.
abstract: Spontaneous bacterial empyema (SBEM) is infection of a preexisting pleural effusion without evidence of pneumonia. It has been reported mostly in patients with hepatic hydrothorax. Only 1 case of SBEM in a noncirrhotic patient has been reported. We present an unusual case of bilateral SBEM from Streptococcus pneumoniae bacteremia in a noncirrhotic patient. A 52-year-old man presented with bilateral pleuritic chest pain and dyspnea for 2 days. His medical history included congestive heart failure, hemodialysis-dependent renal failure and known bilateral pleural effusions. No ascites or hepatosplenomegaly was noticed. Bilateral pleural effusions were again present on physical examination and confirmed by a chest computed tomography scan. Cardiac medical treatment and hemodialysis failed to improve his condition. Bilateral thoracentesis revealed purulent pleural fluid that was culture-positive for Streptococcus pneumonia as were blood cultures. There was no clinical or radiographic evidence of pneumonia. The detailed clinical course, treatment and highlighted points are described.
authors.affiliation: Department of Medicine, Albert Einstein Medical Center, Philadelphia, Pennsylvania 19141, USA. nguyenha@einstein.edu
authors.forename: Ha
authors.initials: H
authors.lastname: Nguyen
authors.forename: Shweta
authors.initials: S
authors.lastname: Gupta
authors.forename: Glenn
authors.initials: G
authors.lastname: Eiger
mesh_terms: D000667:Ampicillin / Q000627:therapeutic use; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D016724:Empyema, Pleural / Q000175:diagnosis* / Q000188:drug therapy / Q000209:etiology / Q000628:therapy; D006801:Humans; D008297:Male; D008875:Middle Aged; D010414:Pennsylvania; D010996:Pleural Effusion / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000382:microbiology; D011008:Pneumococcal Infections / Q000175:diagnosis* / Q000188:drug therapy / Q000209:etiology / Q000628:therapy; D013907:Thoracostomy; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use; D014057:Tomography, X-Ray Computed
chemical_list: D000900:Anti-Bacterial Agents; D000667:Ampicillin; D010959:Tissue Plasminogen Activator