Group B streptococcal empyema necessitatis with pleural fistula after blunt trauma: A case report

INTRODUCTION: We report the first case of empyema necessitatis (EN) with pleural fistula and septic arthritis caused by Streptococcus agalactiae following blunt trauma. PRESENTATION OF THE CASE: A 46-year-old man with diabetes mellitus and a history of recent right rib fracture and right knee bruising presented with dyspnea and right knee pain. He was diagnosed with EN and underwent chest drainage, followed by open-window thoracotomy. Septic arthritis occurred on day 8 after thoracotomy. The chest wall wound healed after 3 months. DISCUSSION: EN is a rare complication of empyema. In this patient, infection was invasive, causing necrotizing pneumonia with a pleural fistula. To our knowledge, there are no reports of group B streptococcal EN with a pleural fistula resulting from blunt chest trauma. CONCLUSION: Group B streptococcal infection might become invasive in immunocompromised patients, so careful follow-up for those patients is important. (C) 2019 The Authors. Published by Elsevier Ltd on behalf of IJS Publishing Group Ltd.