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Kim, Kim, Heo, Lee, Han, Lee, and Kim: A Case of Massive Empyema Caused by Streptococcus constellatus and Anaerobic Bacteria for Mental Retardation
Case Report
Tuberculosis and Respiratory Diseases

Tuberculosis and Respiratory Diseases 2011; 71(6): 476-479.

Published online: 29 December 2011

DOI: https://doi.org/10.4046/trd.2011.71.6.476

A Case of Massive Empyema Caused by Streptococcus constellatus and Anaerobic Bacteria for Mental Retardation

Kyeong-Hyun Kim, M.D., Se-Hyun Kim, M.D., Jeong-Won Heo, M.D., Sang-Hoon Lee, M.D., Seon-Sook Han, M.D., Seoung-Joon Lee, M.D., Woo Jin Kim, M.D.

Department of Internal Medicine, Kangwon National University Hospital, Kangwon National Univsersity School of Medicine, Chuncheon, Korea.

Address for correspondence: Woo Jin Kim, M.D. Department of Internal Medicine, Kangwon National University Hospital, Kangwon National Univsersity School of Medicine, Hyoja 3-dong, Chuncheon 200-722, Korea. Phone: 82-33-258-2454, Fax: 82-33-258-2455, pulmo2@kangwon.ac.kr

Received 16 June 2011       Accepted 21 July 2011

Copyright © 2011. The Korean Academy of Tuberculosis and Respiratory Diseases. All rights reserved.

Abstract

The Streptococcus milleri group, which also includes S. anginosus, S. intermedius and S. constellatus, is found in the oropharynx, upper respiratory tract, gastrointestinal tract, and urogenital tract mucosa. Bacteria in the Streptococcus milleri group are associated with bacteremia and abscess formation. Most of the reports of of Streptococcus milleri group (SMG) infection occur in patients with underlying medical conditions. Predisposing factors that have been associated with S. milleri group empyema include mucosal disturbances (sinusitis, periodontal disease, enteric disease), preceding to pneumonia, thoracic surgery, malignancy, neurological disease, alcohol abuse, and also diabetes mellitus. We report on a 42-year-old man with mental retardation. He who suffered from dyspnea and a fever that he had developed for over 14 days. S. constellatus and anaerobic bacterias (Prevotella buccae and Micromonas micros) were cultured. The patient was treated with the drainage of pleural effusion and clindamycin and levofloxacin.

Keywords: Streptococcus milleri Group, Mental retardation, Empyema

Figures and Tables

Figure 1
(A) Chest AP on admission shows massive pleural effusions and collapsed lung in the right lower lung field. (B) Pleural effusion decreased markedly after 7 weeks of treatment. AP: Anterior-Posterior.
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Figure 2
(A) Multiloculated pleural effusion and air-fluid level are in the right anterior thorax. (B) Follow-up CT after 7 weeks of treatment shows markedly decreased multiloculated pleural effusion in the right thorax. CT: computed tomography.
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