Empyema Quiz: Ace Your Exams

A 34-year-old man comes to the emergency department due to progressive shortness of breath and cough. The patient has had a fever and cough with greenish-yellow sputum for the last six days and developed shortness of breath today. Past medical history is significant for substance use disorder, HIV infection, and infective endocarditis. The patient appears short of breath and anxious. Temperature is 39.9°C (102.82°F), heart rate is 110 bpm, respirations are 26/min, blood pressure is 110/60 mmHg, and oxygen saturation is 94% on room air. Chest auscultation reveals decreased breath sounds at the left lung base with scattered coarse crepitation over the left lung. There is dullness to percussion halfway up the left lung. Cardiac auscultation reveals pan systolic murmur over the left parasternal region. Chest X-ray shows a pleural effusion occupying 60% of the left hemithorax. Point of care ultrasound shows a pleural effusion with loculations and multiple consolidations. A basic laboratory panel shows leukocytosis with glucose of 168 mg/dl. Diagnostic thoracentesis reveals pus, and the results of pleural fluid analysis are shown below. Which of the following would be the most likely findings on pleural fluid analysis?