Tuberculous empyema necessitatis

A 28-year-old male presented with intermittent fever and left-sided chest pain for 1 month. One week before presentation, he developed a gradually progressive painful swelling affecting the posterolateral aspect of the left lower chest. The swelling was 4  × 5 cm in size, red, tender, soft and slightly fluctuating (Figure  1A). Computed tomography of the chest revealed left-sided encapsulated empyema which had ruptured through the left lower chest to communicate externally with a subcutaneous collection of about 5  × 2 cm in size (Figure  1B). Single time needle aspiration of the subcutaneous swelling yielded pus, and the empyema was drained with a percutaneous pigtail catheter (Figure  1C). Nucleic acid amplification test (Xpert MTB/Rif) for Mycobacterium tuberculosis from the pus was positive. Gram stain, bacterial culture and fungal smear were negative. The patient received four drug anti-tuberculosis treatments with clinical improvement.
Source: QJM - Category: Internal Medicine Source Type: research