Department of Medicine, Albert Einstein Medical Center, Philadelphia, Pennsylvania 19141, USA.
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.
自发性细菌性脓胸（SBEM）是指在没有肺炎证据的情况下，先前存在的胸腔积液感染。它主要发生在肝性胸水患者中。仅报道过 1 例非肝硬化患者的 SBEM。我们报告了一例不常见的由肺炎链球菌菌血症引起的非肝硬化患者双侧 SBEM。一名 52 岁男性因双侧胸膜炎胸痛和呼吸困难 2 天就诊。他的病史包括充血性心力衰竭、依赖血液透析的肾衰竭和已知的双侧胸腔积液。未发现腹水或肝脾肿大。体格检查再次发现双侧胸腔积液，并经胸部计算机断层扫描证实。心脏药物治疗和血液透析未能改善他的病情。双侧胸腔穿刺术显示脓性胸腔积液，肺炎链球菌培养阳性，血培养也是如此。没有肺炎的临床或影像学证据。详细的临床过程、治疗和要点如下所述。
