Empyema necessitatis due to Aspergillus fumigatus

Area of Science:

• Medical Mycology
• Thoracic Surgery
• Infectious Diseases

Background:

• Empyema necessitatis is a rare condition involving the extension of a thoracic empyema through the chest wall.
• Aspergillus fumigatus is an opportunistic fungus that can cause severe infections, particularly in immunocompromised individuals.

Observation:

• A 58-year-old woman presented with a painful thoracic skin rash and multiple fistulas.
• Initial antitubercular and antibacterial treatments were ineffective.
• Diagnostic investigations revealed Aspergillus fumigatus in pleural fluid and fungal hyphae in a chest wall biopsy.

Findings:

• The patient was diagnosed with empyema necessitatis secondary to Aspergillus fumigatus infection.
• A combination of surgical debridement of necrotic tissue and systemic antifungal agents led to successful treatment.

Implications:

• This case highlights the importance of considering fungal etiologies in refractory thoracic infections.
• Prompt diagnosis and aggressive management, including surgical and antifungal interventions, are crucial for favorable outcomes in Aspergillus-related empyema necessitatis.