RARE BACTERIAL EMPYEMA AFTER A BLUNT TRAUMA

TOPIC: Disorders of the Pleura TYPE: Medical Student/Resident Case Reports INTRODUCTION: Pleural effusion (PE) is an accumulation excess fluid in pleural space. PE classified as transudative or exudative. Transudative can result from: increased hydrostatic pressure, decreased oncotic forces negative intrapleural pressure. On other hand, exudative from capillary permeability and impaired lymphatic drainage caused by inflammatory processes. Parapneumonic effusions such empyema are related to pneumonia 20-40%. ß hemolytic Lancefield group A streptococcus pyogenes (GAS) a common cause upper respiratory tract cutaneous infections which commonly streptococcal toxic shock syndrome. GAS uncommon pathogen with 1.14 per 100,000 habitants associated bacterial pneumonia, however prevalence only 0.7%. CASE PRESENTATION: 46-year-old man history IVDA who arrived urgency room due shortness breath, dry cough left pleuritic chest pain 3 weeks evolution. He had trauma pedestrian 2 prior arrival. denied fever, night sweats, hemoptysis, palpitations, weight changes. Vitals signs were remarkable for tachycardia, tachypnea peripheral oxygen saturation. Physical examination was bilateral breath sounds side dullness percussion. ABG's supplementation revealed hypercapnia 57.3 mmHg elevated A-a gradient 66.3 mmHg. CBC showed leukocytosis shifting. Chemistry panel metabolic alkalosis 31 mmol/L lactate dehydrogenase 615 IU/L. Chest X-Ray sided white lung, followed CT pleuro-parenchyma fibrotic changes, bullae formation, centrilobular emphysema, patchy ground glass appearance at both lung fields right volume ipsilateral displacement heart mediastinal structures large, multiloculated density. Left thoracentesis performed collecting 120ml purulent fluid, WBC 150,000 PMN 65% gram stain positive. tube placed drain 1400ml brown-yellow culture growth A. Patient started on directed IV antibiotic therapy. DISCUSSION: Empyema pus The M protein, major virulence factor, macromolecule incorporated fimbriae present cell membrane projecting wall. It primary antigenic shift drift among GAS. CONCLUSIONS: We expect contribute awareness knowledge medical field always include working diagnosis all patients progressive dyspnea after blunt trauma. REFERENCE #1: Sakai T, Taniyama D, Takahashi S, Nakamura M, T. syndrome Streptococcus healthy Spanish traveler Japan. IDCases. 2017;9:85-88. Published 2017 Jun 27. doi:10.1016/j.idcr.2017.06.006 #2: Shebl E, Paul M. Effusions And Thoracis. [Updated 2020 Aug 10]. In: StatPearls [Internet]. Treasure Island (FL): Publishing; 2021 Jan-. Available https://www.ncbi.nlm.nih.gov/books/NBK534297/ #3: Tamayo Montes Vicente Pérez-Trallero E. Pneumonia Adults: Clinical Presentation Molecular Characterization Isolates 2006-2015. PLoS One. 2016;11(3):e0152640. 2016 Mar 30. doi:10.1371/journal.pone.0152640 DISCLOSURES: No relevant relationships Maria Betancourt, source=Web Response Marlene Farinacci Vilaro, Kyomara Hernandez-Moya, Arnaldo Nieves-Ortiz, Ivanisse Ortiz Velez, Neshma Roman-Velez,