Over the ensuing 18 hours he developed refractory hypotension, metabolic acidosis, DIC, renal failure, repeated pneumothoraces, ARDS and died. 5064 Microscopically, both lungs contained numerous hemorrhagic abscesses, which were filled with acute inflammatory cells. A streptococcal pneumonia usually occurs in the clinical setting of either a previous viral respiratory tract infection or in closed population groups such as military recruit installations in which there is endemic streptococcal pharyngitis or colonization. Classically, the clinical presentation is acute and patients appear extremely ill, often with marked pleuritic chest pain. On chest film, the combination of a pulmonary infiltrate, unilateral hilar adenopathy and pleural effusion should alert the clinician to a possible streptococcal etiology.
Pleural fluid is often hemorrhagic.
Chest tube drainage and immediate antimicrobial therapy are necessary since the clinical course may be protracted. Adult respiratory distress syndrome defined by acute onset of diffuse pulmonary infiltrates and hypoxemia in the absence of cardiac failure, or evidence of diffuse capillary leak manifested by acute onset of generalized edema, or pleural or peritoneal effusions with hypoalbuminemia. A generalized erythematous macular rash that may desquamate. Soft-tissue necrosis, including necrotizing fasciitis or myositis, or gangrene. The Working Group on Severe Streptococcal Infections.