Case Report Empyema Secondary to Actinomyces meyeri Treated Successfully with Ceftriaxone Followed by Doxycycline Etienne Paris, 1 Tonio Piscopo, 2 and Karen Cassar 3 1 Department of Medicine, Mater Dei Hospital, Msida, Malta 2 General Medicine and Infectious Diseases, Mater Dei Hospital, Msida, Malta 3 General and Acute Medicine, Mater Dei Hospital, Msida, Malta Correspondence should be addressed to Etienne Paris; parisetienne@gmail.com Received 21 July 2016; Revised 31 August 2016; Accepted 1 September 2016 Academic Editor: Larry M. Bush Copyright © 2016 Etienne Paris et al. Tis is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Actinomycosis is a relatively rare infection caused by Gram-positive bacteria. We present the case of a 54-year-old, previously healthy, male patient with a history of severe penicillin allergy who developed severe pneumonia and empyema caused by Actinomyces meyeri. Presenting symptoms included productive cough, right upper quadrant pain, and chills and rigors. He required drainage of the empyema via tube and prolonged antibiotic treatment with intravenous cefriaxone for 2 weeks followed by oral doxycycline for 6 months. 1. Introduction Actinomycosis is a rare infectious disease caused by Gram- positive, non-spore-forming, predominantly anaerobic bac- teria of the Actinomyces genus [1]. Most commonly, it presents as cervicofacial disease with the species Actinomyces israelii being most commonly implicated in humans [2]. However, it can virtually afect any body organ, with pulmonary involvement amounting to around 15% of cases [3]. Pul- monary actinomycosis presents with nonspecifc symptoms and is a rather challenging diagnosis to make, being ofen misdiagnosed as tuberculosis, abscess, or lung malignancy. Penicillin remains the drug of choice in actinomycosis. In this report, we discuss a case of empyema caused by Actinomyces meyeri in a patient allergic to penicillin. 2. Case Presentation A 54-year-old security ofcer presented with a 1-week history of intermittent abdominal pain, mainly in the right upper quadrant, occasionally radiating to the right loin, periumbil- ical area, and right lower chest. Te pain was relieved with NSAIDs but worsened on inspiration and on sitting up. Tere was no relation to food or exertion. He also complained of chills and rigors and chronic productive cough. He had no relevant past medical history other than a history of varicose vein avulsion a few years previously. However, signifcantly, he did report a history of penicillin allergy. He allegedly had an urticarial rash over the arms at 15 years of age when exposed to the drug. He subsequently never tried penicillin again. He was a smoker of 25 cigarettes daily and binged on alcohol during weekends. On clinical examination, the patient was alert and fully oriented. He was apyrexial, with oxygen saturations of 94% in room air and a respiratory rate of 20 breaths per minute. Blood pressure and heart rate were within normal limits. Heart sounds were unremarkable. Respiratory examination revealed decreased air entry in the right base, with a stony dull percussion note. Tere were also few sparse expiratory wheezes. Te abdomen was completely sof and nontender. Murphy’s sign and renal punches were all negative. Multiple dental caries were evident, but otherwise there were no splinter haemorrhages, clubbing, or lymphadenopathy. Chest radiography confrmed a right-sided pleural efu- sion with probable collapse of the right middle and lower lung lobes (Figure 1). CT scan of the trunk revealed right- sided middle and lower lobe pulmonary consolidations with a moderate sized pleural efusion. Tere was no evidence of underlying malignancy (Figure 2). Blood tests revealed a Hindawi Publishing Corporation Case Reports in Infectious Diseases Volume 2016, Article ID 9627414, 3 pages http://dx.doi.org/10.1155/2016/9627414