Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Case Reports
. 2023 May:106:108300.
doi: 10.1016/j.ijscr.2023.108300. Epub 2023 May 4.

Necrotizing fasciitis of the chest wall caused by empyema necessitans following tuberculosis: Case report and literature review

Nebiyou Bayileyegn  1 , Dawit Teka Mengiste  2
Affiliations
Case Reports

Necrotizing fasciitis of the chest wall caused by empyema necessitans following tuberculosis: Case report and literature review

Nebiyou Bayileyegn et al. Int J Surg Case Rep. 2023 May.

Abstract

Introduction and importance: Empyema is a serious complication characterized by pus and bacteria in the pleural space which may progress to necrosis, cavitation, or fistulas in the thoracic cavity. Infection and trauma are the commonest causes in the developed countries while tuberculosis is the commonest cause of empyema in developing countries. Empyema necessitans is a rare complication of pleural space infections.

Case presentation: A 50 years old male patient presented to our hospital with right side chest pain and shortness of breath of 3-week duration. He had completed treatment of pulmonary tuberculosis 6 months ago. The patient was apparently healthy for the last six months after the treatment. The patient was acutely sick looking and has tachycardia with pulse rate of 115, respiratory rate was 36 and arterial oxygen saturation of 80 % with atmospheric air but becomes 96 % with facemask humidified oxygen. Tube thoracostomy and chest wall debridement was done for empyema necessitans with chest wall necrotizing fasciitis.

Clinical discussion: Empyematous collection with time may lead to a more complicated scenario called empyema necessitans. Empyema necessitans is the dissection of puss thru the pleural space and collection in the torso/ free rupture with or without collection of air. The most common cause of empyema globally is untreated parapneumonic effusion. Tuberculosis constitutes for most of the cases of empyema necessitans in third world countries. Debridement and wound care are monumental for the management of necrotizing fasciitis in addition to broad spectrum antibiotics.

Conclusion: Timely treatment/drug adherence to pneumonia and tuberculosis decreases the rate of having empyema and subsequent complication. Chest wall necrotizing fasciitis is extremely rare and judicious management with debridement and wound care is appropriate whenever it happens. Broad spectrum antibiotics with drainage are the norm of management of empyema/empyema necessitans.

Keywords: Case report; Empyema; Empyema necessitans; Necrotizing fasciitis; Tuberculosis.

PubMed Disclaimer

Conflict of interest statement

Competing interest The author declares that there are no competing interests.

Figures

Fig. 1
Fig. 1
A & B Shiny and blackish discolored overlying skin on the right chest wall.
Fig. 1
Fig. 1
A & B Shiny and blackish discolored overlying skin on the right chest wall.
Fig. 2
Fig. 2
Chest X-ray showing massive right pleural effusion with white out lung and pushed mediastinum.
Fig. 3
Fig. 3
A & B Chest ultrasound showing pleural collection with echo debris.
Fig. 3
Fig. 3
A & B Chest ultrasound showing pleural collection with echo debris.
Fig. 4
Fig. 4
A Incisions used for debridement and serve as limiting incision. Healthy looking and bleeding skin and clamped chest tube. B Incisions used for debridement and serve as limiting incision. Healthy looking and bleeding skin and clamped chest tube.
Fig. 4
Fig. 4
A Incisions used for debridement and serve as limiting incision. Healthy looking and bleeding skin and clamped chest tube. B Incisions used for debridement and serve as limiting incision. Healthy looking and bleeding skin and clamped chest tube.
Fig. 5
Fig. 5
Healed incision and chest wound with skin abutting to chest wall.
Fig. 6
Fig. 6
Fully expanded right lung with some parenchymal consolidation.
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

References

    1. Letheulle J., et al. Parapneumonic pleural effusions: epidemiology, diagnosis, classification and management. Rev. Mal. Respir. 2015;32(4):344–357. doi: 10.1016/j.rmr.2014.12.001. - DOI - PubMed
    1. Fletcher M.A., Schmitt H.-J., Syrochkina M., Sylvester G. Pneumococcal empyema and complicated pneumonias: global trends in incidence, prevalence, and serotype epidemiology. Eur. J. Clin. Microbiol. Infect. Dis. 2014;33(6):879–910. doi: 10.1007/s10096-014-2062-6. - DOI - PMC - PubMed
    1. Semenkovich T.R., Olsen M.A., Puri V., Meyers B.F., Kozower B.D. Current state of empyema management. Ann. Thorac. Surg. 2018;105(6):1589–1596. doi: 10.1016/j.athoracsur.2018.02.027. - DOI - PMC - PubMed
    1. Arnold D.T., et al. Epidemiology of pleural empyema in english hospitals and the impact of influenza. Eur. Respir. J. 2021;57(6):2003546. doi: 10.1183/13993003.03546-2020. - DOI - PMC - PubMed
    1. Maskell N.A., Batt S., Hedley E.L., Davies C.W.H., Gillespie S.H., Davies R.J.O. The bacteriology of pleural infection by genetic and standard methods and its mortality significance. Am. J. Respir. Crit. Care Med. 2006;174(7):817–823. doi: 10.1164/rccm.200601-074OC. - DOI - PubMed

Publication types