An infectious disease physician reported that 30 month old female received a 4th dose of Prevnar vaccine when she was 12 months old. On 1/28/03, the child developed a high fever and hard coughing causing chest pain. She was seen in the pediatrician's office. A routine x-ray showed pneumonia in the left lung. On 1/31/03, she developed high fevers of 104 degrees F and was hospitalized. A computerized tomogram showed consolidation in the left lung and a small pleural effusion; however, not enough for a chest tube placement. Fluid was drawn. A blood culture was negative. On day 3, a thoracentesis was performed and susceptibility and serotyping was done. An effusion culture was positive for Streptococcus pneumoniae, serogroup 19. The patient was initially treated with clindamycin but was switched to ampicillin after sensitivity to penicillin was shown. Oxygen dependency was increasing so a repeat computerized tomography scan was done 1 week after onset showing severe effusion. At this time, fluid was removed and two chest tubes were placed. A culture was negative. The patient was transferred to tertiary care at another hospital. The patient no longer requires oxygen and the chest tubes were removed 2/12/03. The ampicillin was discontinued and she is currently on IV cefotaxime. The patient was described as moving about without any problems. The physician plans to discharge the patient from the hospital on 2/16/03. Follow up received on 4/8/03 from physician. Stated that hte pt recovered and included additional details about pt's diagnosis, hospital stay and course of treatment. An infectious disease physician reported that 30 month old female received a 4th dose of Prevnar vaccine on 7/5/01, when she was 12 months old. On 1/28/03, the child developed a "high" fever and "hard" coughing causing chest pain. She was seen in the pediatrician's office. A routine x-ray showed pneumonia in a left lung. On 1/31/03, she developed high fevers of 104 deg F. and was hospitalized. A computerized tomogram showed consolidation in the left lung and a small pleural effusion; however, not enough for a chest tube placement. A blood culture was negative. On day 3, a thoracentesis was performed and susceptibility and serotypind was done. An effusion culture was positive for Streptococcus pneumoniae, serogroup 19. The pt was initially treated with clindamycin but was switched to ampicillin after sensitivity to penicillin was shown. Oxygen dependency was increasing so a repeat computerized tomography scan was done 1 week after onset showing severe effusion. At this time, fluid was removed and two chest tubes were placed. A culture was negative. The pt wsa transferred to tertiary care at another hospital on 2/8/03. That evening, she underwent a left-sided thoracotomy and vat decortication drainage of the left empyema. Two chest tubes were placed on her left side. On 2/11/03 a chest tube was removed and she showed clinical signs of improvement with no complications following her surgery. On 2/12/03, a second chest tube was removed and she remained clinically stable. Over the next three days, she clinically showed signs of improvement with no complications following her surgery. On 2/12/03, a clinically showed signs of improvement. She was able to be weaned off of her oxygen management and the chest tubes were removed 2/12/03. Pain management was also significantly improved and she able to be taken off IV analgesia. The ampicillin was discontinued and she is currently on IV cefotaxime. the IV cefotaxime was discontinued on 2/25/03. The pt was described as "moving about without any problems." The physician discharged the pt from the hospital on 2/15/03 and she recovered. A follow up appointment on 2/25/03 revealed the pt was asymptomatic and a chest x-ray revealed normal lung fields.