Empyema Necessitans Due to Methicillin-Sensitive Staphylococcus aureus: Case Report and Review

Empyema refers to a collection of pus in the pleural cavity. Empyema necessitans is a rare complication of an empyema that refers to an insidious extension of the pus through the parietal pleura into the neighboring subcutaneous tissue of the chest wall or, less often, other thoracic structures. Left untreated, the purulent material may penetrate the chest wall forming a fistula or subcutaneous abscess. Drainage and empiric antimicrobial therapy should be started when the diagnosis is made and adjusted once the infecting organism is identified. Mycobacterium tuberculosis and Actinomyces species, both generally slow-growing microbes, remain the most common pathogens associated with the development of empyema necessitans. Although rarely encountered in the postantibiotic era, acute infections involving pyogenic organisms including Staphylococcus aureus may serve as the etiologic agents associated with this problematic subset of pleural effusion. The majority of reported cases of empyema necessitans due to S. aureus have occurred with strains that are methicillin resistant. This case describes a 70-year-old man who, after a month long of symptoms, presented with empyema necessitans due to methicillin-sensitive S. aureus. This case underscores the importance of diagnosing an empyema and treating early with antibiotics in order to avoid subsequent surgical intervention if and when empyema necessitans should develop.
Source: Infectious Diseases in Clinical Practice - Category: Infectious Diseases Tags: Review Articles Source Type: research