Pneumonia with empyema: rare complication after sea urchin injury

Abstract

Staphylococcal pneumonias are rare, especially in immunocompetent children. They can represent a complication of tissue infection with hematogeneous dissemination. Sea urchin injuries can result in local reactions, granulomas and, unfrequently, systemic disease. We describe the case of a 16-year-old boy with a four-day fever and left-sided chest pain, with referral to a sea urchin injury five days before admission. Physical examination revealed diminished pulmonary sounds and crackles in the left lower hemithorax. The chest radiograph showed a pleural effusion. Blood tests showed leukocytosis, neutrophilia, and an elevated C-reactive protein. Empyema was diagnosed after performing a thoracentesis. Subsequently he initiated inflammatory signs with fluctuation on his right heel, with purulent drainage. Suspecting on a staphylococcal etiology, he was treated with flucloxacillin, a suspicion that was confirmed by the isolation of Staphylococcus aureus in pleural liquid and abscess material. After antibiotic treatment was established, there was a favorable clinical and radiological evolution. With this case report, we would like to draw attention to the possibility of hematogenous dissemination of a microorganism after local skin infection, even in immunocompetent individuals.