title: A case of multiple empyema caused by Streptococcus intermedius.
abstract: We report the case of a patient with multiple empyema present throughout his body, including chronic sinusitis and chronic suppurative otitis media, as well as subsequent epidural empyema, all caused by Streptococcus intermedius. A 38-year-old man presented with chief complaints of headache, left ear discharge, and nasal congestion. Imaging studies revealed pansinusitis, soft tissue signs in the mastoid cells, and otitis media. The patient was treated with meropenem hydrate, 6g/day. While clinical findings indicated improvement of the sinusitis, his headache did not improve. Further examination with contrast computerized tomography (CT) 'a chest radiography' blood cultures were performed, and the patient was diagnosed with multiple empyema (with an epidural empyema, pulmonary suppuration) caused by S. intermedius. Subsequent burr hole drainage was implemented to drain the epidural empyema. Long-term administration was required to treat pulmonary suppuration. While they remain rare, there has been a recent upward trend in the frequency of cases in which a young, previously healthy patient has developed multiple empyema throughout their body despite the absence of complicating diseases that pose an immune deficiency risk, such as diabetes or infection with the human immunodeficiency virus (HIV). In order to properly diagnose and treat patients presenting with multiple empyema infection with S. intermedius should be included in the differential diagnosis.
authors.affiliation: Department of Otorhinolaryngology, Juntendo University Urayasu Hospital, 2-1-1 Tomioka, Urayasu-shi, Chiba 279-0021, Japan. Electronic address: a-kaga@juntendo.ac.jp.
authors.forename: Akihito
authors.initials: A
authors.lastname: Kaga
authors.affiliation: Department of Otorhinolaryngology, Juntendo University Urayasu Hospital, 2-1-1 Tomioka, Urayasu-shi, Chiba 279-0021, Japan.
authors.forename: Ryuzaburo
authors.initials: R
authors.lastname: Higo
authors.affiliation: Department of Otorhinolaryngology, Juntendo University Urayasu Hospital, 2-1-1 Tomioka, Urayasu-shi, Chiba 279-0021, Japan.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Yoshikawa
authors.affiliation: Department of Otorhinolaryngology, Juntendo University Urayasu Hospital, 2-1-1 Tomioka, Urayasu-shi, Chiba 279-0021, Japan.
authors.forename: Naoko
authors.initials: N
authors.lastname: Yokoi
authors.affiliation: Department of Otorhinolaryngology, Juntendo University Urayasu Hospital, 2-1-1 Tomioka, Urayasu-shi, Chiba 279-0021, Japan.
authors.forename: Takuo
authors.initials: T
authors.lastname: Haruyama
authors.affiliation: Department of Otorhinolaryngology, Juntendo University Urayasu Hospital, 2-1-1 Tomioka, Urayasu-shi, Chiba 279-0021, Japan.
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Komatsu
authors.affiliation: Department of Otorhinolaryngology, Juntendo University Urayasu Hospital, 2-1-1 Tomioka, Urayasu-shi, Chiba 279-0021, Japan.
authors.forename: Ayumi
authors.initials: A
authors.lastname: Yabe
authors.affiliation: Department of Otorhinolaryngology, Juntendo University Shiuzoka Hospital, 1129 Nagaoka, Izunokuni-shi, Shizuoka 410-2295, Japan.
authors.forename: Takeshi
authors.initials: T
authors.lastname: Kusunoki
authors.affiliation: Department of Otorhinolaryngology, Juntendo University, 3-1-3 bunkyou-ku honngo, Tokyo 113-8431, Japan.
authors.forename: Katsuhisa
authors.initials: K
authors.lastname: Ikeda
mesh_terms: D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D002908:Chronic Disease; D004322:Drainage; D020802:Epidural Abscess / Q000150:complications / Q000000981:diagnostic imaging* / Q000628:therapy; D006801:Humans; D008297:Male; D000077731:Meropenem; D010035:Otitis Media, Suppurative / Q000150:complications / Q000000981:diagnostic imaging* / Q000188:drug therapy; D013902:Radiography, Thoracic; D012852:Sinusitis / Q000150:complications / Q000000981:diagnostic imaging* / Q000188:drug therapy; D013290:Streptococcal Infections / Q000000981:diagnostic imaging* / Q000628:therapy; D034367:Streptococcus intermedius; D013845:Thienamycins / Q000627:therapeutic use; D014057:Tomography, X-Ray Computed
chemical_list: D000900:Anti-Bacterial Agents; D013845:Thienamycins; D000077731:Meropenem
keywords: Bur hole drainage; Mastoidectomy; Multiple empyema; Otitis media; Pansinusitus; Streptococcus intermedius