Empyema Necessitans Complicating Pleural Effusion Associated with<i>Proteus</i>Species Infection: A Diagnostic Dilemma

Yauba, M. S.; Ahmed, H.S.; Imoudu, Iragbogie Al-Mustapha; Yusuf, Maimuna O.; Makarfi, Hauwa U.

doi:10.1155/2015/108174

Cited by 17 publications

(23 citation statements)

References 10 publications

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“…However, Bacteroides is a common cause of intrapulmonary abscess and pleural infection. Yauba et al [ 8 ] described a pediatric case of EN due to Proteus species and discussed challenges in diagnosis and management as it was difficult to differentiate between tuberculous and nontuberculous effusions.…”

Section: Discussionmentioning

confidence: 99%

Empyema Necessitans in the Setting of Methicillin-Susceptible Staphylococcus aureus Causing Pneumonia and Bacteremia

Bandaru

Manthri

Sundareshan

et al. 2018

Case Reports in Infectious Diseases

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Empyema necessitans (EN) is a rare phenomenon that refers to an insidious extension of the empyema through parietal pleura and subsequent dissection into subcutaneous tissue of the chest wall. A 29-year-old man presented to the hospital with fever and chills a few days after an inadvertent needle stick while injecting heroin. His left forearm was warm with an area of fluctuance. He underwent incision and drainage of the left forearm abscess with fluid submitted for Gram stain and culture. His condition rapidly deteriorated due to sepsis, and he required transfer to the intensive care unit. A new 4 × 3 cm area over the left pectoralis muscle had become increasingly indurated, fluctuant, and erythematous. CT of the chest demonstrated extensive cavitary lung lesions and a large loculated left-sided pleural effusion with extension through the chest wall. TEE revealed a 3 cm complex lesion on the superior septal leaflet of the tricuspid valve. The patient underwent incision and drainage of the pectoralis major EN with placement of a drain. Blood and sputum cultures grew methicillin-susceptible Staphylococcus aureus (MSSA) at which time antibiotic therapy was tailored to oxacillin. Our case highlights a rare occurrence of EN due to MSSA in a patient with intravenous drug use (IDU) and underscores the importance of prompt diagnosis and treatment.

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Section: Discussionmentioning

confidence: 99%

Empyema Necessitans in the Setting of Methicillin-Susceptible Staphylococcus aureus Causing Pneumonia and Bacteremia

Bandaru

Manthri

Sundareshan

et al. 2018

Case Reports in Infectious Diseases

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“…Other rare complications like purulent pericarditis, pulmonary abscess, peritonitis from extension through diaphragm and osteomyelitis of adjacent rib can occur. 4…”

Section: Discussionmentioning

confidence: 99%

Empyema necessitans, a rare complication of empyema thoracis

Chaudhary¹,

Bhowmik²,

Datta³

et al. 2018

IJRRT

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| http://medcraveonline.com rise in temperature was noted. Since, the swelling was confined to soft tissue, contrast enhanced Magnetic Resonance Imaging (MRI) was advised which showed a peripheral rim enhancing, large, multilobulated T1WI hypointense and T2WI hyperintense lesion in right posterior chest wall having multiple internal septations. The lesion was involving the intercostal space and intercostal muscles. Cortical irregularity and altered marrow signal intensity was noted at 6 th and 7 th ribs of right posterior chest wall. Similar characteristics lesion was noted in the right posterior pleural space which appeared communicating with the posterior chest wall lesion. Ultrasound (US) examination of the swelling was done which showed hypoechoic, multi lobulated mass which showed no vascularity on color flow. Hence, ultrasound guided fine needle aspiration (FNA) was done; from which thick purulent yellowish colored pus was aspirated and was sent for gram stain, acid fast bacillus, culture and sensitivity. Pus culture revealed Mycobacterium tuberculosis. Based on this, thoracotomy with decortication was done. Patient was treated with intravenous antibiotics and discharged home on oral antibiotics with significant improvement (Figure 1 & Figure 2).

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“…EN results from the poorly or uncontrolled long-term complication of empyema and usually occurs after necrotizing pneumonia or pulmonary abscess. Pleural effusion with empyema necessitans is usually caused by Mycobacterium tuberculosis and Actinomyces israelii [ 29 ]. Other microbial causes include Pneumococci, Staph aureus, and Proteus.…”

Section: Reviewmentioning

confidence: 99%

From Chest Wall Resection to Medical Management: The Continued Saga of Parapneumonic Effusion Management and Future Directions

Santoshi¹,

Chandar²,

Gupta

et al. 2022

Cureus

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Pleural space infections have been described since the time of Hippocrates and to this day remains a significant pathology. Every year in the USA approximately there are one million hospital admissions for pneumonia with 20%-40% associated with some form of pleural space infections leading to pleural effusions with increased morbidity and mortality. Often, management of these effusions mandate combination of medical treatment and surgical drainage with debridement and decortication. There has been a lot of ongoing research regarding the safety and efficacy of intrapleural fibrinolytics in the management of complicated pleural effusions and empyema. Till this day, areas of debate and controversies exist among clinicians treating pleural space infection. Empyema is historically considered a surgical disease. There have been societies and guidelines for the management of infected parapneumonic effusions with antibiotics and chest tube drainage as an initial empiric treatment modality. With the advances in the use of Intrapleural fibrinolytics and minimally invasive procedures such as video-assisted thoracoscopic surgery (VATS), empyema a surgical disease is now more favoring medical management. Surgical option, such as open thoracotomy, is reserved for patients who failed conservative management and chronic empyema. The aim of this comprehensive review is to shed light on the evolution of various management strategies from the era of Hippocrates to current day practice and how there continues to be a paradigm shift in treating empyema as a surgical condition to a medical disease.

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Empyema Necessitans Complicating Pleural Effusion Associated withProteusSpecies Infection: A Diagnostic Dilemma

Cited by 17 publications

References 10 publications

Empyema Necessitans in the Setting of Methicillin-Susceptible Staphylococcus aureus Causing Pneumonia and Bacteremia

Empyema Necessitans in the Setting of Methicillin-Susceptible Staphylococcus aureus Causing Pneumonia and Bacteremia

Empyema necessitans, a rare complication of empyema thoracis

From Chest Wall Resection to Medical Management: The Continued Saga of Parapneumonic Effusion Management and Future Directions

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