No abstract

The most common cause of empyema is a complicated parapneumonic effusion, but other foci of infection may also spread to the pleural space. A man in his early 30s with a history of testicular mixed germ cell tumor presented with a week of pleuritic chest pain. On admission, he was tachypneic, tachycardic, and had tested positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Imaging revealed a loculated large left pleural effusion with collapse of the left lung. A pigtail catheter was inserted, and the pleural effusion was evacuated. Fluid analysis indicated infection with Actinomyces meyeri. Clinical exam and mandible radiography ruled out infectious facial involvement. Intravenous ampicillin was started, but two days later the patient requested that the chest tube be removed, and he left the hospital against medical advice. The patient followed-up in our clinic one month later with a significantly improved medical condition. Treatment with oral amoxicillin-clavulanate for twelve months was prescribed.

Patients presenting with comorbid stimulant use disorder is a common occurrence in nearly all medical specialties. New clinical strategies to care for patients experiencing stimulant withdrawal should be considered as an effort to improve clinical outcomes. Our patient, a woman in her early 20s with a history of substance use disorder and unspecified bipolar and related disorder, presented with acute psychosis with symptoms including agitation, auditory hallucinations, and delusions in the context of chronic mental illness and cocaine abuse. She was subsequently admitted to the inpatient psychiatry unit. Notable symptoms included mood swings, erratic behavior, anger, and agitation. Mood and psychotic symptoms were treated with olanzapine. She also received medications, including haloperidol, lorazepam, and diphenhydramine, as needed for agitation, which were given as an emergency treat option (ETO) injection. The patient continuously exhibited irritability and endorsed that she was undergoing cocaine withdrawal symptoms, for which she was started on bupropion. Within days of taking this medication, she reported significant improvement in her psychotic and mood symptoms. The patient continued this treatment during the remainder of her stay until the resolution of her symptoms and was discharged with both bupropion and olanzapine to continue while awaiting an outpatient psychiatry appointment in one week.