Abstract
BACKGROUND: Empyema is a serious complication of lung surgery. CASE PRESENTATION: We report a case of Streptococcus anginosus empyema complicated by descending necrotizing fasciitis after surgery. Ten days after the initial surgery, the patient presented with arrhythmia and hypotension with septic shock. Pleural fluid analysis led to the diagnosis of empyema, and surgical debridement (second surgery) was performed. One week after the emergency surgery, a palpable pink erythematous skin change was observed on the ipsilateral iliac crest. Hence, the second emergency surgery (third surgery) was performed to debride the subcutaneous and intramuscular abscesses. CONCLUSIONS: The possibility of descending abscess and necrotizing fasciitis should be considered when Streptococcus anginosus is detected.