Empyema Necessitatis in a Patient on Peritoneal Dialysis

Moh, In Ho; Lee, Young-Ki; Kim, Hee Joon; Jung, Harry; Park, Jae Hyun; Ahn, Hye-Kyung; Noh, Jung‐Woo

doi:10.4046/trd.2014.77.2.94

Cited by 7 publications

(14 citation statements)

References 14 publications

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“…The most common site of involvement is in the anterior chest wall, specifically, midclavicular and anterior axillary line and between the second and sixth intercostal spaces. Moreover, it is also reported to involve bronchus, vertebral column, diaphragm, breast, mediastinum, retroperitoneum, esophagus, pericardium, flank, or groin [10].…”

Section: Case Presentationmentioning

confidence: 99%

“…There are reviewed articles by Sindel (1940), Freeman et al (2004) and Llamas-Velasco et al (2010), respectively, who described mycobacterium tuberculosis as the most common cause of EN cases. They also highlighted the importance of antibiotics in its management due to the decline in the mortality rate from 66% in the pre-antibiotic era to 5% nowadays [10]. In literature, most reported cases described the association of EN with bacterial pathogens like Mycobacterium, Staphylococcus aureus (MSSA and MRSA), and Actinomycosis [10][11][12][13].…”

Section: Case Presentationmentioning

confidence: 99%

“…They also highlighted the importance of antibiotics in its management due to the decline in the mortality rate from 66% in the pre-antibiotic era to 5% nowadays [10]. In literature, most reported cases described the association of EN with bacterial pathogens like Mycobacterium, Staphylococcus aureus (MSSA and MRSA), and Actinomycosis [10][11][12][13]. In our case, the patient initially was treated for empyema due to ESBL E. coli organism with appropriate antibiotics and chest tube thoracostomy for drainage of the infected fluid.…”

Section: Case Presentationmentioning

confidence: 99%

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A Rare and Challenging Presentation of Empyema Necessitans/Necessitasis Leading to Brachial Plexopathy

Abufaied¹,

Iqbal²,

Yassin³

2020

Cureus

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Empyema necessitasis (EN) also referred to as empyema necessitans (EN) is a rare complication of empyema that can involve soft tissues outside the pleural cavity and can lead to brachial plexus injury. Although, brachial plexus injury most commonly occurs as a result of trauma, inflammation, or malignancies, but it has been rarely seen in EN. We are reporting a rare and challenging case of empyema necessitasis (EN) causing impingement of brachial plexus in a 42-year-old, type 2 diabetic patient, who initially presented to the hospital with left-sided pleuritic chest pain and acute onset of left upper limb weakness. Urgent CT brain ruled out an acute neurological insult. Chest radiograph and contrast-enhanced CT thorax revealed left-sided loculated effusion. MRI of the left upper limb showed impingement of brachial plexus by the inflammatory process of surrounding effusion. Ultrasound-guided aspiration of the encapsulated fluid was performed and culture analysis of the fluid was remarkable for Prevotella oris (sensitive strain) growth. After drainage of the infected fluid and with a prolonged course of antibiotics, the patient's neurological symptoms improved significantly. Hospital course was uncomplicated and further follow-up was unremarkable for any deterioration. Our objective is to emphasize on the prompt management with close follow-up in EN, which can present with life-threatening complications as seen in our case. Any delay can compromise the patient's health. As per our limited knowledge, this case has not been reported in the literature.

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Section: Case Presentationmentioning

confidence: 99%

Section: Case Presentationmentioning

confidence: 99%

Section: Case Presentationmentioning

confidence: 99%

See 1 more Smart Citation

A Rare and Challenging Presentation of Empyema Necessitans/Necessitasis Leading to Brachial Plexopathy

Abufaied¹,

Iqbal²,

Yassin³

2020

Cureus

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“…Combination of surgical drainage with ATT along with physiotherapy for improving pulmonary functions is the most effective method of treatment [6]. Almost all ATT can cause Stevens–Johnson syndrome (SJS) as an adverse effect [7, 8]. If it occurs, introducing ATT in a staged fashion with combination of first- and second-line drugs is recommended [8–10].…”

Section: Introductionmentioning

confidence: 99%

“…Almost all ATT can cause Stevens–Johnson syndrome (SJS) as an adverse effect [7, 8]. If it occurs, introducing ATT in a staged fashion with combination of first- and second-line drugs is recommended [8–10].…”

Section: Introductionmentioning

confidence: 99%

Empyema Necessitans due to Interruption of Antituberculosis Treatment

Benaragama

Pushpakumara

Wanigasuriya

2019

Case Reports in Infectious Diseases

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Empyema necessitans is a rare presentation of tuberculous infection, commonly encountered in immunocompromised patients. The diagnosis can be challenging due to the paucibacillary nature of the condition and nonspecific symptoms. Identifying the organism in culture is the gold standard method of diagnosis. We describe a patient with chronic kidney disease, who developed empyema necessitans due to interruption of antituberculous therapy. Initially, he was started on antituberculous therapy based on a clinical diagnosis of smear-negative pulmonary tuberculous infection; this resulted in Stevens–Johnson syndrome needing a long course of steroid therapy. He later presented with a painful chest lump and was diagnosed as empyema necessitans. Finding the etiology for this rare presentation lead to a diagnostic dilemma, finally confirming the TB infection from the culture. This case highlights the importance of being aware of unusual complications of tuberculous infection in immunocompromised settings.

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