Spontaneous Escherichia coli Empyema Thoracis: An Unusual Occurrence in a Non-cirrhotic, Immunocompetent Individual

Abstract

Spontaneous bacterial empyema is a spontaneous infection of the pleural cavity in the absence of pneumonia, typically seen in patients with liver cirrhosis and preexisting hepatic hydrothorax. Empyema thoracis caused by Escherichia coli (E. coli) is a rare clinical finding and, in most cases, a consequence of E. coli pneumonia. Spontaneous bacterial empyema secondary to E. coli in a non-cirrhotic individual is an unusual association, rarely described in the literature. To the best of our knowledge, this is the first case of spontaneous bacterial E. coli empyema thoracis in a non-cirrhotic, immunocompetent individual with a complex medical history including pulmonary thromboembolism, oropharyngeal dysphagia, and a high aspiration risk of oropharyngeal secretions.

Keywords: complex medical history; escherichia coli empyema; high aspiration risk; non-cirrhotic; oropharyngeal dysphagia; pulmonary thromboembolism; spontaneous bacterial empyema.

Figure 1. Chest X-ray anteroposterior view demonstrating left pleural effusion

Figure 2. Computed tomography of the chest demonstrating pulmonary thromboembolism in the left main pulmonary artery (red arrow) and large loculated left-sided pleural effusion (green arrow)

Figure 3. Computed tomography of the chest demonstrating calcifications in the left lower lobe of the lung, suggestive of microaspirations (red arrow)

Figure 4. TTE parasternal short-axis view at mid-left ventricular cavity level demonstrating reduced biventricular function

TTE: transthoracic echocardiography