Empyema necessitans is a rare long-term complication of poorly or uncontrolled empyema thoracis characterized by the dissection of pus. Images in Clinical Medicine from The New England Journal of Medicine — Tuberculosis Empyema Necessitatis. Images in Clinical Medicine from The New England Journal of Medicine — Empyema Necessitatis.

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Management of this case was challenging as this case was malnourished and features of TB may not be prominent.

Empyema Necessitans: An Unexpected Infectious Presentation of Multiple Myeloma

Check for errors and try again. Management options include closed or open drainage of the pleural space to necessitns fibrosis and to facilitate expansion of the lung. Increased risk of invasive pneumococcal disease in haematological and solid-organ malignancies. This is an open access article distributed under the Creative Commons Attribution Licensewhich permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

The bone survey demonstrated multiple lytic lesions. There was associated difficulty in breathing but no discoloration of the mucous membrane. The dramatic resolution of symptoms in this case with anti- Proteus antibiotics could also suggest empyema necessitans complicating pleural effusion secondary to Proteus species.

Treatment of this condition would include antibiotics, tube drainage, and decortication for obliterating the cavity and regenerating pulmonary function. Indexed in Web of Science.


The management of this case was challenging since it was difficult to differentiate between tuberculous and nontuberculous effusion in this case. Diagnosis of tuberculosis in this case was based on history only since investigation did not support the diagnosis. Cough was insidious in onset and productive of purulent and nonbloody sputum. This case was treated with quinolones, antituberculous drugs, chest tube drainage, and nutritional rehabilitation.

Empyema necessitans is a rare complication of pleural space infection. A year-old male with no significant medical history came to the emergency department with worsening right-sided chest swelling associated with fever, chills, night sweats, and weight loss, following sudden-onset rib pain 7—8 months prior.

Pulmonary infections with Gram negative organisms like Proteus spp. An initial diagnosis of pleural effusion with empyema necessitans secondary to pulmonary tuberculosis in anaemic heart failure was made Figure 1.

Empyema necessitatis Empyema necessitatis EN.

Empyema Necessitans

No history of contact with tuberculosis or chronically coughing adult. About Blog Go ad-free. Pleural effusion with empyema necessitans is a cause of morbidity and mortality in children. Developmental and nutritional history was uneventful. This is in conformity with the reports by some workers [ 78 ] who documented the etiologic agents to be Gram negative bacilli, Streptococcus pneumoniaeStaphylococcus aureus, and Blastomycosis.

We report a child with pleural effusion and empyema necessitans secondary to Proteus spp. There was a stony dull percussion note on the right hemithorax but dull empjema notes on the left hemithorax. Aspiration of the soft tissue mass revealed S.


Empyema Necessitans: An Unexpected Infectious Presentation of Multiple Myeloma

Appetite had been good but there was associated weight loss. Empyema necessitans is necessktans rare long-term complication of poorly or uncontrolled empyema thoracis characterized by the dissection of pus through the soft tissues and skin of the chest wall [ 1 ].

Case Reports in Pediatrics. View at Google Scholar W. Diagnostic utility and clinical application of imaging for pleural space infections. Early diagnosis and management of pleural effusion would prevent the development of empyema necessitans but our patient was not diagnosed and managed early necessitating the development of this complication [ 11 ].

It is commonly associated with pulmonary tuberculosis, Actinomycesand nontuberculous organisms like Staphylococcus aureus.

The isolation of Proteus species necewsitans the pleural fluid aspirate and wound swab suggests Proteus as the etiologic agent of the parapneumonic effusion. He was febrile However, there were challenges in differentiating between Mycobacterium tuberculosis and nontuberculous empyema in a resource poor setting like ours.