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Acute Pyelonephritis II: Diagnostic Studies and Management

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Related Experiment Videos

Empyema necessitatis revisited.

Mar Llamas-Velasco1, Inmaculada Domínguez, Enrique Ovejero

  • 1Department of Dermatology, Hospital Universitario de la Princesa, CP 28006, Madrid, Spain. mar.llamasvelasco@gmail.com

European Journal of Dermatology : EJD
|October 14, 2009
PubMed
Summary

Empyema necessitatis is a rare condition presenting as a thoracic mass. Early recognition and treatment are crucial for survival, with Actinomyces and MRSA emerging as significant causes.

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Area of Science:

  • Dermatology
  • Infectious Diseases
  • Thoracic Medicine

Background:

  • Empyema necessitatis (EN) is a rare condition often overlooked in dermatology.
  • Prompt diagnosis and treatment are vital to prevent mortality.

Observation:

  • A 32-year-old woman with anorexia nervosa presented with an enlarging, fluctuating mass on her right thoracic wall.
  • Actinomyces gerencseriae was identified as the primary etiological agent.

Findings:

  • While Mycobacterium tuberculosis remains the most common cause (35%), Actinomyces (25%) and MRSA (10%) are increasingly prevalent.
  • The typical dermatological sign is a subacute, erythematous, fluctuating mass on the chest wall.
  • Modern treatments have reduced mortality rates.

Implications:

  • Enlarging, painful, and fluctuating thoracic masses warrant suspicion for EN.
  • Diagnostic workup should include chest X-ray to exclude underlying pulmonary infection.
  • Dermatologists must be aware of EN to ensure timely diagnosis and management of this potentially fatal condition.