A 78-year-old woman with a prior stroke is not feeling well. Her appetite is poor, and today her family noticed that she is confused so they send her to the emergency room for an assessment. She reports no cough, fever, or sputum production but her CXR reveals a left lower lobe infiltrate. Blood cultures are drawn, and she is started on antibiotics. The next day the cultures are positive for S pneumoniae sensitive to penicillin. Which of the following is the most likely complication of pneumococcal pneumonia?
High-Yield Explanation
Approximately 2% of cases of pneumococcal pneumonia are complicated by empyema. However, not all pleural effusions in the setting of pneumococcal pneumonia represent pleural infection. Frank pus, a positive Gram stain, or a pH = 7.1 on thoracentesis suggest empyema and the need for aggressive drainage with a chest tube.