Successful use of streptokinase for the treatment of empyema thoracis during advanced pregnancy: A case report

Summary 

Pneumonia complicates as many as 2.7 in every 1000 pregnancies putting both mother and fetus at increased risk. Parapneumonic pleural effusion is generally managed by thoracocentesis and, if “complicated”, by tube thoracostomy. If conservative management is unsuccessful, surgical decortication may be necessary. We report the case of a 24 year old gravida, who at 33 weeks of gestation presented to the emergency department with right sided pneumonia complicated by empyema. Blood and pleural fluid cultures were positive for Streptococcus pneumonia. Treatment with antibiotics, tube thoracsotomy and interpleural streptokinase led to resolution of the pneumonia and empyema without the need for surgical intervention. The patient carried her pregnancy to term and delivered a healthy baby after 39 weeks and 5 days of gestation. To our knowledge this is the first report of empyema treated with streptokinase in advanced pregnancy.

Keywords: Streptokinase, Empyema, Pregnancy

Abbreviations: VATS, Video assisted thoracoscopic surgery, ACCP, American college of chest physicians