Spontaneous bacterial empyema in a noncirrhotic patient: an unusual scenario

Am J Med Sci. 2011 Dec;342(6):521-3. doi: 10.1097/MAJ.0b013e31822c9512.


Spontaneous bacterial empyema (SBEM) is infection of a preexisting pleural effusion without evidence of pneumonia. It has been reported mostly in patients with hepatic hydrothorax. Only 1 case of SBEM in a noncirrhotic patient has been reported. We present an unusual case of bilateral SBEM from Streptococcus pneumoniae bacteremia in a noncirrhotic patient. A 52-year-old man presented with bilateral pleuritic chest pain and dyspnea for 2 days. His medical history included congestive heart failure, hemodialysis-dependent renal failure and known bilateral pleural effusions. No ascites or hepatosplenomegaly was noticed. Bilateral pleural effusions were again present on physical examination and confirmed by a chest computed tomography scan. Cardiac medical treatment and hemodialysis failed to improve his condition. Bilateral thoracentesis revealed purulent pleural fluid that was culture-positive for Streptococcus pneumonia as were blood cultures. There was no clinical or radiographic evidence of pneumonia. The detailed clinical course, treatment and highlighted points are described.

Publication types

  • Case Reports

MeSH terms

  • Ampicillin / therapeutic use
  • Anti-Bacterial Agents / therapeutic use
  • Empyema, Pleural / diagnosis*
  • Empyema, Pleural / drug therapy
  • Empyema, Pleural / etiology
  • Empyema, Pleural / therapy
  • Humans
  • Male
  • Middle Aged
  • Pennsylvania
  • Pleural Effusion / diagnostic imaging
  • Pleural Effusion / drug therapy
  • Pleural Effusion / microbiology
  • Pneumococcal Infections / diagnosis*
  • Pneumococcal Infections / drug therapy
  • Pneumococcal Infections / etiology
  • Pneumococcal Infections / therapy
  • Thoracostomy
  • Tissue Plasminogen Activator / therapeutic use
  • Tomography, X-Ray Computed


  • Anti-Bacterial Agents
  • Ampicillin
  • Tissue Plasminogen Activator