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Bacterial coinfections are not uncommon with respiratory viral pathogens. These coinfections can add to significant mortality and morbidity. We are currently dealing with the SARS-CoV-2 pandemic, which has affected over 15 million people globally with over half a million deaths. Previous respiratory viral pandemics have taught us that bacterial coinfections can lead to higher mortality and morbidity. However, there is limited literature on the current SARS-CoV-2 pandemic and associated coinfections, which reported infection rates varying between 1% and 8% based on various cross-sectional studies. In one meta-analysis of coinfections in COVID-19, rates of Streptococcus pneumoniae coinfections have been negligible when compared to previous influenza pandemics. Current literature does not favor the use of empiric, broad-spectrum antibiotics in confirmed SARS-CoV-2 infections. We present three cases of confirmed SARS-CoV-2 infections complicated by Streptococcus pneumoniae coinfection. These cases demonstrate the importance of concomitant testing for common pathogens despite the need for antimicrobial stewardship.

Pulmonary pneumatocele is a cystic, air-filled lesion in the lung parenchyma. It results from underlying inflammation or bronchial injury. It is seen in several lung pathologies including bacterial pneumonia, positive-pressure ventilation, chest trauma, chemical pneumonitis, and is most often seen in infants and children. On imaging, pneumatoceles appear as rounded, thin-walled, air-filled spaces in the lung parenchyma. The exact mechanism for forming pneumatoceles is not fully understood but thought to be due to a check-valve mechanism due to obstruction by inflammation causing air trapping in the damaged lung. These lesions are asymptomatic and transient in most patients and disappear by about 6 weeks. They usually do not require any specific treatment or intervention. Surgical intervention is only necessary when pneumatoceles cause cardiopulmonary compromise or rupture into the pleural space. We describe a case of a young adult who developed a pneumatocele after developing acute respiratory distress syndrome from community-acquired pneumonia treated with positive-pressure ventilation. He was managed conservatively with complete resolution of symptoms.

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