Explosive Pleurisy Related to Group a Streptococcal Infection: A Case Report and Literature Review

Al-Mashat M*, Moudgal V and Hopper JA

Explosive Pleurisy Related to Group a Streptococcal Infection: A Case Report and Literature Review.

GAS can cause a wide spectrum of disease ranging from non-invasive infections like
pharyngitis and cellulitis, to invasive infections like bacteremia, streptococcal toxic shock
syndrome, necrotizing fasciitis and pneumonia.

Pneumonia related to GAS is known to be associated with a high rate of occurrence of pleural effusion and empyema, contributing to significant morbidity and mortality that may reach up to 50%, especially in the settings of streptococcal toxic shock syndrome.

Pneumonia related to GAS is rarely associated with a rapidly progressing pleural effusion termed “explosive pleurisy” that is usually a complicated exudative parapneumonic effusion that is considered a medical emergency requiring immediate intervention.

We report a case of explosive pleurisy that was successfully
identified and treated with decortication and drainage through VATS.

A 27-year-old male school teacher who has been
healthy with no significant past
medical or surgical history presented to the hospital 7 days
after the development of
what was felt to be a simple cold.

The patient reported developing sore throat and nasal congestion 2 days after
coming back from vacation. His symptoms improved over the next few days but he
then developed fever and chills, which were associated with shortness of breath and productive cough.

The shortness of breath progressed rapidly and his primary physician diagnosed him
with pneumonia and concomitant reactive airway disease.

His shortness of breath continued to worsen over the next 24 hours and was then
associated with upper abdominal pain, nausea, vomiting and diarrhea. He had
a brief history of smoking as a teen but quit more than 10 years
prior to this presentation, and he denied any alcohol or illicit drug abuse.

Pulm Res Respir Med Open J. 2015; 2(3): 109-113. doi: 10.17140/PRRMOJ-2-117