Post-viral influenza Streptococcus pneumoniae pneumonia in an intravenous drug abuser

Viral influenza is a seasonal cause of community-acquired pneumonia (CAP). Viral influenza may be caused by influenza A or B and affect any age group. Viral influenza A is usually more severe than influenza B in adults. Viral influenza may present as 3 clinical scenarios: viral influenza alone, viral influenza followed in 1 to 3 days by Staphylococcus aureus pneumonia, or viral influenza followed in 1 to 3 weeks by pneumonia caused by Streptococcus pneumoniae or Haemophilus influenzae. Intravenous drug abusers (IVDAs) are predisposed to a variety of infectious diseases but are not particularly predisposed to viral influenza. We present a case of a young IVDA who presented with influenza A pneumonia who subsequently developed S. pneumoniae CAP. The pneumonococcal suprainfection was severe and prolonged and characterized by a small cavity, empyema, pneumatoceles, and bronchopleural fistulae. S. pneumoniae pleural effusions are uncommon, but pleural empyemas are often demonstrated. Tracheobronchial fistulae and cavitation are rare complications of S. pneumoniae CAP in adults. To the best of our knowledge, this is the first case of post-viral influenza pneumococcal pneumonia in an IVDA.