Case Report: Actinomyces meyeri empyema in a COVID-19 positive patient with history of testicular mixed germ cell tumor

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.