Empyema necessitans caused by actinomycosis: A case report

Area of Science:

• Thoracic Surgery
• Infectious Diseases
• Pulmonary Medicine

Background:

• Pulmonary actinomycosis is a rare thoracic infection.
• Empyema necessitans is an uncommon presentation, often leading to misdiagnosis.
• Thoracic surgeons must be familiar with varied presentations and management strategies.

Purpose of the Study:

• To describe an uncommon clinical presentation of pulmonary actinomycosis.
• To report successful management of actinomycosis empyema necessitans.
• To highlight the benefits of early, limited operative intervention.

Main Methods:

• A 56-year-old male presented with chest wall swelling and pain.
• Imaging revealed a mass suspicious for infection or neoplasia.
• Surgical exploration with aggressive chest wall debridement was performed without thoracotomy.

Main Results:

• Actinomyces was identified on final pathology, confirming actinomycosis empyema necessitans.
• The patient's condition was successfully managed with limited surgery.
• Avoidance of thoracotomy and pulmonary resection was achieved.

Conclusions:

• Actinomycosis empyema necessitans can be successfully treated with early, limited operative intervention.
• Thoracotomy and pulmonary resection may be avoided in cases with minimal pulmonary involvement.
• Limited surgical debridement and appropriate antibiotic therapy are key to successful outcomes.