Background Streptococcus pneumonia is the most common cause of community acquired pneumonia in children below five.

Case report We describe the case of a nineyearold boy, who subsequently developed an abscess of pleura and invasive pneumococcal bacteremia. The boy was admitted by a surgeon when he presented with abdominal pain and vomiting accompanied by mild cough and fiver.

Investigations showed CRP386mgl, ESR140mmh, WBC30Gl 13 bands79 seg8 lymph, fibrinogen496mgdl, Ddimer2223ngml and FDPs.

Chest Xray revealed lower left lobe consolidation with pleural inflammation. A repeat chest Xray performed five days after admission, because of increasing dyspnea, disclosed progression of inflammatory process in the left lung and pleural effusion. Chest CT showed extensive interstitialalveolar changes in the left lung with atelectasis and pleural effusion causing reduction of lung volume up to the fourth rib.

Since hospital day six suction drainage and intrapleural administration of alteplase were continued for 5days. Intravenous antibiotics were administered for 32days, initially cefuroxime and netilmicin, which were than replaced, following an antibiogram, by benzylpenicyllin 15days, then cefotaxime and clindamycin for 14days. Intravenous immunoglobulin were administered on 3rd and 5th day of treatment. Course of disease was complicated with labial herpes and acute adenoviral gastroenteritis, despite concurrent treatment since the first day of treatment.

In an otherwise normal following examination one month after treatment only a tiny pleural adhesion in the left costophrenic angle was found.

Conclusions Intrapleural administration of alteplase enhanced efficacy of suction drainage and saved the patient from invasive surgical intervention. Administration of pneumococcal conjugated vaccine could have prevented invasive pneumococcal disease in the boy.