Novel case of empyema necessitans caused by Mycobacterium xenopi

Abstract

Poorly controlled long-standing empyema can dissect through soft tissues and skin resulting in empyema necessitans. We present the first reported case of empyema necessitans caused by Mycobacterium xenopi, which was treated successfully with antimycobacterial therapy. The case highlights the indolent nature of the pathogen and the importance of an accurate diagnosis.

Keywords: Empyema; Infections; Pleural infection.

Figure 1

Postoperative (A) and empyema necessitans chest (B) CT scans. Lung (above) and mediastinal (below) windows of each CT are shown. Moderate right pneumothorax and extensive pleural opacities are evident on the right postoperatively, at the time of initial recovery of M. xenopi (A). Site of chest tube drainage, denoted by arrow, corresponds with site of communication between the right pleural empyema and subcutaneous fluid collection (arrow) 2 years later (B).

Figure 2

Chest CT scan of resolved empyema necessitans. Lung (above) and mediastinal (below) windows are shown. Pleural-cutaneous communication is no longer present with residual pleural thickening. Persistent nodules and bronchiectasis were present in all CT scans.