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.

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Background: Thoracic empyema is a collection of pus in the pleural space. Empyema necessitatis is a rare complication of empyema, characterized by the dissection of pus through the soft tissues of the chest wall and eventually through the skin. We present nine cases of empyema necessitatis, including etiology, duration, and characteristics of clinical history, kind of surgery used, and treatment choices.

Methods: In a 4-year period nine patients were treated for empyema necessitatis. Results: Empyema necessitatis was treated with drainage and antibiotherapy or antituberculosis therapy in three patients with the diagnosis of tuberculosis or nonspecific pleuritis. Decortication of the thoracic cavity was used in three patients successfully. Others were treated with open drainage. Final diagnoses were tuberculous empyema in five patients, chronic fibrinous pleuritis in three, and squamous cell carcinoma in one.

Except for two patients, one with multisystem failure and one with squamous cell carcinoma, all were discharged with no complications. Conclusion: Surgery plays a critical role in the management of empyema necessitatis in selected patients. Tube drainage, open drainage, and decortication are the choices in variable conditions for obliterating the cavity and regenerating pulmonary function. This site needs JavaScript to work properly. Please enable it to take advantage of the complete set of features!

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Full-text links Cite Favorites. Abstract Background: Thoracic empyema is a collection of pus in the pleural space. Comment in Approach to empyema necessitatis.

Peverada PT. World J Surg. PMID: No abstract available. Similar articles Factors affecting morbidity in chronic tuberculous empyema. Sonmezoglu Y, et al. Thorac Cardiovasc Surg. PMID: Wang C, et al. Zhonghua Wai Ke Za Zhi. PMID: Chinese. Cutaneous tumefaction in empyema necessitatis. Reyes CV. Int J Dermatol. Empyema necessitatis due to methicillin-resistant Staphylococcus aureus: case report and review of the literature. Mizell KN, et al. J Clin Microbiol.

Epub Jul Tuberculous empyema. Sahn SA, et al. Semin Respir Infect. PMID: Review. Show more similar articles See all similar articles. Cited by 10 articles Risk factors for tuberculous empyema in pleural tuberculosis patients. Wen P, et al. Sci Rep. Stage-directed therapy of pleural empyema. Reichert M, et al. Langenbecks Arch Surg. Epub Nov 4. Babamahmoodi F, et al. Case Rep Infect Dis.

Empyema necessitans complicating pleural effusion associated with proteus species infection: a diagnostic dilemma. Yauba MS, et al. Case Rep Pediatr. Epub Mar Empyema necessitatis due to Aspergillus fumigatus. Lee HW, et al. BMJ Case Rep. Show more "Cited by" articles See all "Cited by" articles.

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A rare presentation of empyema necessitatis

Empyema necessitans, a rare complication of pleural effusion, could result in significant morbidity and mortality in children. It is characterized by the dissection of pus through the soft tissues and the skin of the chest wall. Mycobacterium tuberculosis and Actinomyces israelii are common causes but Gram negative bacilli could be a rare cause. However, there were challenges in differentiating between Mycobacterium tuberculosis and nontuberculous empyema in a resource poor setting like ours. We report a child with pleural effusion and empyema necessitans secondary to Proteus spp. We describe a year-old child with empyema necessitans complicating pleural effusion and highlight management challenges. This case was treated with quinolones, antituberculous drugs, chest tube drainage, and nutritional rehabilitation.


Empyema Necessitans due to Interruption of Antituberculosis Treatment

Empyema necessitatis is characterized by an extension of pus empyema thoracic from pleural cavities to the surrounding structures such as chest wall, mediastinum, pericardium, esophagus, retroperitoneum and so on. A 5-year-old boy was presented, in surgical emergency of our institution, with discharge of pus from a cervical lump during inspiration. There was a history of fever, cough and respiratory distress 10 days back, followed by the appearance of a lump in the right cervical region. The parents sought medical treatment from a local dispensary. A day back the lump spontaneously bursted with cupious amount of pus came out of the cervical lump.

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