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

Abstract

Group A Streptococcus (GAS) can cause invasive infections, such as pneumonia. It 
is rarely associated with a rapidly progressing exudative pleural effusion termed “explosive 
pleurisy”, leading to significant morbidity and mortality. A 27-year-old healthy man developed sore throat 1 week prior to admission and then progressively developed fever, chills and 
shortness of breath. Upon presentation, his vitals were remarkable for an oral temperature of 
102.4 F, blood pressure of 89/64, heart rate of 124, respiratory rate of 40 and a pulse oximeter 
reading of 84%. Examination revealed pharyngeal erythema and exudates, and decreased 
right chest expansion with diminished breath sounds and dullness to percussion on the right. 
Labs revealed leukocytosis of 13,000/mcl White Blood Cells (WBC) (Normal 3,500-10,500 
cells/mcl). Chest radiographs showed early pneumonia with a small pleural effusion. A CT 
scan of the chest was performed 4 hours later, revealing the presence of right middle and 
lower lobe pneumonia and a moderate-sized pleural effusion. A chest tube was placed and 
drained serosanguinous fluid. Cultures of the pleural fluid grew GAS. The patient was treated 
with intravenous Penicillin G and Clindamycin. The patient continued to deteriorate, despite 
antibiotics and the empyema worsened despite presence of a chest tube. Video Assisted Thoracoscopic Surgery (VATS) with decortication and drainage was performed with significant 
improvement of the patient’s condition. GAS pneumonia can progress rapidly with development of complicated parapneumonic effusions and empyema, the so-called ‘explosive pleurisy’. Early surgical intervention may result in quicker symptom resolution and may minimize 
morbidity.