Explosive Pleurisy Related to Group a Streptococcal Infection: A Case Report and Literature Review

Abstract

Group A Streptococcus (GAS) can cause invasive infections, such as pneumonia. It is rarely associated with a rapidly progressing exudative pleural effusion termed “explosive pleurisy”, leading to significant morbidity and mortality. A 27-year-old healthy man devel-oped sore throat 1 week prior to admission and then progressively developed fever, chills and shortness of breath. Upon presentation, his vitals were remarkable for an oral temperature of 102.4 F, blood pressure of 89/64, heart rate of 124, respiratory rate of 40 and a pulse oximeter reading of 84%. Examination revealed pharyngeal erythema and exudates, and decreased right chest expansion with diminished breath sounds and dullness to percussion on the right. Labs revealed leukocytosis of 13,000/mcl White Blood Cells (WBC) (Normal 3,500-10,500 cells/mcl). Chest radiographs showed early pneumonia with a small pleural effusion. A CT scan of the chest was performed 4 hours later, revealing the presence of right middle and lower lobe pneumonia and a moderate-sized pleural effusion. A chest tube was placed and drained serosanguinous fluid. Cultures of the pleural fluid grew GAS. The patient was treated with intravenous Penicillin G and Clindamycin. The patient continued to deteriorate, despite antibiotics and the empyema worsened despite presence of a chest tube. Video Assisted Tho-racoscopic Surgery (VATS) with decortication and drainage was performed with significant improvement of the patient’s condition. GAS pneumonia can progress rapidly with development of complicated parapneumonic effusions and empyema, the so-called ‘explosive pleurisy’. Early surgical intervention may result in quicker symptom resolution and may minimize morbidity.