A Man in His 30s Presenting With Shortness of Breath and Productive Cough After a Recent Pneumonia

Streptococcus intermedius Brain Abscess with Lung Abscess and Aortic Valve Endocarditis: A Case Report and Literature Review

Streptococcus intermedius is frequently associated with brain and liver abscesses, while pleuropulmonary infections are considered rarer. Even less frequent is the association of lung and brain abscesses due to this agent with infective endocarditis. We describe the case of a 40-year-old man complaining of cough, fever, and headache who was diagnosed with a brain abscess due to S. intermedius, a concomitant lung abscess, and aortic native valve endocarditis. He was treated with surgical drainage of the brain abscess and a 4-week course of intravenous ceftriaxone, followed by oral amoxicillin/clavulanate, obtaining healing of the lesions without relapse of the infection.

Streptococcus intermedius Pleuropulmonary Disease: A Not So Commonly Seen Radiological Picture

A Streptococcus (S.) intermedius-associated pleuropulmonary infection (PPI) is a rare presentation. Cases have been reported in the last decade in which S. intermedius was identified in pleural fluid cultures and lung biopsies in patients presenting with complicated pleural effusions and empyema. However, there are data lacking on predisposing factors, mode of dissemination, and treatment strategies for these patients. Moreover, these patients can present with a spectrum of radiographic findings, which can help with prompt diagnosis and effective patient management. However, the radiological findings in this patient and the rapidly worsening clinical symptoms make the diagnosis difficult.

Ultrasound for Pleural Disease. Beyond a Pocket of Pleural Fluid

The evolution of pleural disease imaging modalities through the years has helped the scientific community understand and treat various disease states. Ultrasound (US) has been an image modality that has reigned superior to those used in the past such as chest X-ray and computed tomographic scan in terms of cost effectiveness, portability, and reduction in unwarranted radiation exposure to patients. Here we provide a succinct review of US use in pleural disease including imaging techniques, identifying safe pleural space for access, and predicting pleural fluid volume and etiology along with specificities regarding trapped lung identification and pleural mass biopsy. We believe bedside chest US is an adjunct to the physical exam adding superior diagnostic abilities. Further research is warranted in more specific aspects of sonographic use such as in fibrinolytic therapy management, evaluation for trapped lung, and the utility of specific modes like the color flow Doppler.