Empiema necessitatis por Staphylococcus aureus

Abstract

Empyema necessitatis is a collection of exudative fluid in the pleural space extending across the parietal pleura into the surrounding tissue forming a fistulous tract. The most common etiologic agents are: Mycobacterium tuberculosis, Actinomyces israelii, Streptococcus pneumoniae, Escherichia coli, Pseudomonas aeruginosa, Aspergillus sp, anaerobes and less frequently by Staphylococcus aureus. The cases of empyema necessitatis are reported more frequently in immunosuppressed patients with risk factors such as type 2 diabetes, chronic alcoholism, poor dental health, chronic obstructive pulmonary disease, smoking, cachexia and bronchiectasis. We report the case of 54 years old male with a history of chronic alcohol abuse and poorly controlled type 2 diabetes, with history of 2 weeks of fever, progressive dyspnea, chest pain and erythema, hyperthermia and swelling in the right subclavian region. Clinically with pleural effusion syndrome. With tomographic evidence of fistulous tract and bacterial isolation the diagnosis was made. The patient had a severe infectious condition requiring antibiotic treatment and surgical resolution with excellent evolution.