Community-Acquired, Post-COVID-19, Methicillin-Resistant Staphylococcus aureus Pneumonia and Empyema

The coronavirus disease 2019 (COVID-19) pandemic has presented unprecedented challenges to the healthcare system globally, with opportunistic and secondary infections being one of the biggest challenges. Most secondary infections occur as nosocomial infections due to exposure to multidrug-resistant organisms in healthcare facilities. Secondary bacterial pneumonia complicates the care of hospitalized COVID-19 pneumonia patients. We present the case of a 77-year-old male who was diagnosed with COVID-19 pneumonia about four weeks before the current presentation to the hospital and was treated symptomatically in the community setting. During workup, he was diagnosed with multifocal pneumonia and right-sided empyema caused by methicillin-resistant Staphylococcus aureus (MRSA). He underwent chest tube thoracostomy followed by intrapleural fibrinolysis along with targeted antibiotic therapy. He needed video-assisted thoracoscopy with decortication due to inadequate improvement with intrapleural fibrinolysis. This case is a rare presentation of a community-acquired MRSA lung infection that occurred after recovery from COVID-19 pneumonia. This case emphasizes the importance of monitoring for secondary infections, as well as highlights the extent of secondary infections in COVID-19.