Empyema Necessitans Due to Tuberculosis in a Patient With Poorly Controlled Diabetes Mellitus Type 2: A Case Report

Empyema necessitans (EN) is a rare condition characterized by the accumulation of pus in the extra-thoracic soft tissue due to decompression of intrathoracic empyema by extending through the parietal pleura and chest wall usually by Mycobacterium tuberculosis. This is a report of a patient with poorly controlled diabetes mellitus type 2 presenting with high-grade fever, productive cough, dyspnoea and a left-sided pleuritic chest pain complicated by a left pleural effusion. It further extended to extra-thoracic soft tissue space without fistulation to the external environment. Non-specific signs coupled with the paucibacillary status of extrapulmonary tuberculosis may obscure the diagnosis of EN in extrapulmonary tuberculosis. However, this patient had greatly an exudative pleural effusion with raised adenosine deaminase levels highly suggestive of extrapulmonary tuberculosis. The patient underwent surgical clearance and insertion of a thoracotomy tube. He was commenced on antitubercular medication for which he had a successful recovery.