Pleural empyema due to group a beta-hemolytic streptococci in an adult.

palmoplantar pigmentation. Postgrad Med J 2001;77:268 & 277. 3. Cherian S. Palmoplantar pigmentation: A clue to Alkaptonuric ochronosis. J Am Acad Dermatol 1994:30:284-5. 4. Suwannarat P, Phornphutkul C, Bernardini I, Turner M, Gahl WA. Minocycline-induced hyperpigmentation masquerading as alkaptonuria in individuals with joint pain. Arthritis Rheum 2004;50:3698-701. 5. Bruce S, Tschen JA, Chow D. Exogenous ochronosis resulting from quinine njections. J Am Acad Dermatol 1986;15:357-61. PaCO2 27.6 mmHg and PaO2 87.2 mmHg. A chest radiograph showed a small left pleural effusion. Thoracocentesis was performed and thick, foul smelling, cloudy yellowish pus aspirated and sent for bacterial culture along with a blood sample. The patient was administered parenteral antibiotics (ceftriaxone, amikacin and vancomycin) and was also started on parenteral insulin for control of the blood sugar level. However, the chest pain and breathlessness worsened over the next 12 hours. A computed tomograph (CT) scan revealed a well-defined sharply marginated collection in the left hemithorax with thickened smooth walls and loculated effusion (155×139× 84 mm).