Abstract
Streptococcus intermedius lung abscess and empyema is a chronic infectious process associated with a high morbidity and mortality. It is typically seen in adults, and is considered a rare disease process in the pediatric population. Our case describes a 17 year old male presenting with 3 months of cough associated with later development of chest and back pain. He was later found to have a severe empyema secondary to Streptococcus intermedius. This case underlines a rare diagnosis in the pediatric population, as well as a association with smoking and vaping.
Highlights
Streptococcus intermedius lung abscess and empyema is a chronic infectious process associated with a high morbidity and mortality
There is a significant amount of evidence being introduced that indicates smoking as a precipitant for common lung parenchymal infections, but there has only been minimal evidence linking marijuana or vaping to Streptococcus intermedius empyema
Case. 17-year-old Caucasian male with no significant past medical history presented with chronic cough for 3 months
Summary
To discuss differential of chronic cough in an adolescent male, etiology and pathophysiology of Streptococcus intermedius empyema and the relationship between smoking, vaping, and empyema. 17-year-old Caucasian male with no significant past medical history presented with chronic cough for 3 months. Patient had multiple outpatient clinic visits with no improvement in his clinical status. Chest imaging showed opacities and multifocal area of fluid collection in the right lung with associated mediastinal shift to the left (Figure 1A, 1B, and 1C). Past social history was negative for recent travel, animal exposure, sick contact, IV drug use, but was positive for marijuana smoking, vaping, and incarceration a few months prior to presentation. Two chest tubes were placed in the two largest areas of fluid collection on day 1. Serial chest x-rays were performed which showed progressive resolution of empyema (Figure 2A). Chest CT was performed 3 months after discharge showing complete resolution (Figures 2B and 2C).
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