一位五歲四個月大的女孩，因咳嗽流鼻水兩個禮拜，又高燒及劇烈咳嗽四天來求診，胸部X光顯示右上肺大葉性肺炎併膿胸因而住院。胸部超音波顯示右側肺實質化及肋膜積膿，肺部電腦斷層攝影顯示右上及右下肺肺炎合併肋膜積膿。病人於是接受了微小開胸手術並進行皮質剝脫術及胸管插入加引流治療。術後病人逐漸退燒，肋膜積液培養長出肺炎鏈球菌，抗生素持續治療兩週，待肋膜積液量逐漸減少，病人於出院前接受了肋膜黏連鬆解術，門診追蹤的X光顯示肺炎明顯改善且病人並無任何後遺症，此病人曾接種過7價肺炎鏈球菌疫苗，但仍得到肺炎鏈球菌肺炎併膿胸，乃感染到其他血清型別之肺炎鏈球菌，如此更突顯出即將上市之13價肺炎鏈球菌疫苗之重要性。

We describe the case of a girl 5 years and 4 months old who presented with fever for 4 days and cough with rhinorrhea for 2 weeks and who was diagnosed with right upper lobe (RUL) lobar pneumonia with empyema. A chest x-ray (CXR) revealed RUL consolidation. Chest sonography revealed right-side pleural effusion and right-side pneumonia. Chest computed tomography revealed RUL and right lower lobe (RLL) pneumonia with right-side pleural effusion. Decortication and drainage with chest tube insertion were done via a minithoracotomy. The pleural effusion culture grew Streptococcus pneumoniae. Antibiotics were used until discharge. The amount of chest tube drainage decreased, and adhesiolysis was performed. Her fever subsided, and follow-up CXR showed considerable improvement. She was discharged and followed-up in the outpatient department.