The chest cavity is opened at autopsy to reveal a large amount of purulent fluid in the right pleural cavity. The pleural surface of the right lung is covered with a purulent exudate. This is an empyema. The patient had a neurodegenerative disorder that increased the risk for aspiration pneumonia. The pneumonia spread to the pleural surface. A gram stain of the purulent fluid showed numerous neutrophils along with gram positive cocci in chains and clusters. Both Staphylococcus aureus and Streptococcus pneumoniae were cultured.