A case of empyema caused by group G Streptococcus following extrapleural lucite ball plombage performed 64 years previously

Abstract

An 83-year-old man, who had received right extrapleural lucite ball plombage for pulmonary tuberculosis 64 years previously presented to our hospital complaining of fever. Chest radiograph and CT revealed empyema. Thoracentesis was performed, and the pus obtained revealed group G streptococcus. We diagnosed this patient with empyema caused by group G streptococcus, extirpated the lucite balls, and performed fenestration. Twenty-two months after the operation, omentoplasty was carried out. Prolonged air leakage from a bronchial fistula continued, but the air leakage disappeared on bronchial embolization using EWS (Endobronchial Watanabe Spigot). After this episode, the postoperative course was uneventful.

In the 1940-50s, surgical treatment for pulmonary tuberculosis played a very important role, especially in collapse therapies, such as thoracoplasty or plombage. Extrapleural lucite ball plombage was one of them, but it soon disappeared because of its various associated complications. Suvivors also experience late complications such as empyema. However, it is also true that this patient had been free of tuberculosis and asymptomatic for 64 years. Cases of extirpated lucite ball plombage have rarely been reported, and so we report this Japanese case.