Successful pregnancy in a patient with severe superior vena cava syndrome.

FEV, .o = one second forced expiratory volume MMEFR = maximum mid-expiratory flow PEFR =peak rate expiratory flow rate immediately drained, which was putrid and contained a white blood cell count of 56,00O/ml, with 95 percent lymphocytes and 5 percent polymorphonuclear cells. Drainage of pus from the chest tube continued for three weeks thereafter. Gram stains of the empyema fluid revealed gram + badlli and coccilobadllarv forms without the detection of sulfur granules. Numerous sputa cultures grew normal flora. Aerobic and anaerobic cultures of the empyema fluid grew only A naedundi, the identity of which was confirmed by the Mycology Laboratory of the New York City Department of H d t h. The patient ran high remittent temperatures of up to 38.Q°C over the first 17 days of her hospitalization, but became afebrile by the end of the third week of penicillin therapy. She was also treated with a lincomycin analogue (Cllndamydn) in addition to penicillin for four weeks.5.6 After nine weeks of penicillin therapy she underwent thora-&my for a decortication procedure. The pathologic examination of resected fibrous tissue showed only chronic nonspe-ci6c inflammation. The penicillin therapy was continued for another week, and the patient was discharged without any medication. She has been asymptomatic over the three months since discharge, with recovery of her pulmonary function (Table 1). The patient showed several of the clinical findings characteristic of previous reports of actinomycosis. While she had no definite history of loss of consciousness or aspiration, and was not an alcoholic, she did have carious teeth and pyorrhea. She also clearly demonstrated the tenacity of the fungus to maintain an established suppurative infection despite massive antibiotic and drainage therapy, which eventually necessitated decortication. The finding of the A naeslundi organism is unique because even A israeli is rarely found to be the only organism present in a suspected actinomycotic le-sion. This frequently makes it difEcult to exclude a pathogenic role for accompanying anaerobic bacteria. The cellular and colonial morphologic characteristics of A naeslundi, while very similar to those of A israeli, can be differentiated by cultural characteristics, primarily their ability for aerobic growth.' It is most important to identify this organism rapidly, for it appears to be similar to A israeli in both its response to antibiotic therapy and its ability to destroy lung t i s s ~ e. ~ ? ~ MBC =maximum breathing capacity RV = residual volume TLC …