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Empyema necessitans complicating pleural effusion associated with proteus species infection: a diagnostic dilemma
M S Yauba1, H Ahmed2, I A Imoudu2
1Department of Paediatrics, University of Maiduguri College of Medical Sciences, Maiduguri 752106, Nigeria.
Abstract:
Background. Empyema necessitans, a rare complication of pleural effusion, could result in significant morbidity and mortality in children. It is characterized by the dissection of pus through the soft tissues and the skin of the chest wall. Mycobacterium tuberculosis and Actinomyces israelii are common causes but Gram negative bacilli could be a rare cause. However, there were challenges in differentiating between Mycobacterium tuberculosis and nontuberculous empyema in a resource poor setting like ours. We report a child with pleural effusion and empyema necessitans secondary to Proteus spp. infection. Methods. We describe a 12-year-old child with empyema necessitans complicating pleural effusion and highlight management challenges. Results. This case was treated with quinolones, antituberculous drugs, chest tube drainage, and nutritional rehabilitation. Conclusion. Empyema necessitatis is a rare condition that can be caused by Gram negative bacterial pathogens like Proteus species.
Insights
Empyema necessitans, a rare chest infection, can be caused by Gram-negative bacteria like Proteus species. This case highlights challenges in diagnosis and treatment in children.
Area of Science:
- Pediatric Infectious Diseases
- Pulmonology
- Microbiology
Background:
- Empyema necessitans is a rare complication of pleural effusion, presenting with pus dissection through soft tissues and skin.
- While Mycobacterium tuberculosis and Actinomyces israelii are common causes, Gram-negative bacilli are rare etiologies.
- Distinguishing between tuberculous and non-tuberculous empyema poses challenges, particularly in resource-limited settings.
Purpose of the Study:
- To report a case of empyema necessitans secondary to Proteus spp. infection in a child.
- To highlight the diagnostic and management challenges associated with this rare condition.
Main Methods:
- A case study of a 12-year-old child with empyema necessitans complicating pleural effusion is described.
- Management involved a combination of antibiotics, antitubercular drugs, chest tube drainage, and nutritional support.
Main Results:
- The patient presented with empyema necessitans.
- Successful treatment was achieved with quinolones, antituberculous drugs, chest tube drainage, and nutritional rehabilitation.
Conclusions:
- Empyema necessitatis can be a rare manifestation of Gram-negative bacterial infections, such as Proteus species.
- This case underscores the importance of considering diverse pathogens in pediatric empyema necessitans.
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