Complex Interplay of Empyema and Chylothorax: A Case Report With Nutritional and Clinical Implication

Empyema and chylothorax are distinct but serious pleural space complications, with the simultaneous occurrence being exceedingly rare and clinically challenging. We present the case of a 78-year-old immunocompromised male with small-cell lung cancer who developed concurrent empyema and chylothorax. The patient presented with respiratory distress and signs of sepsis, and imaging revealed pleural effusion with lung collapse. Thoracostomy yielded a large volume of milky, purulent chylous fluid positive for Streptococcus sp., confirming infected chylothorax (empyema). Management included broad-spectrum tailored antibiotics, chest tube drainage, octreotide administration, and a parenteral nutrition regimen to address nutritional losses from chyle leakage. Despite initial clinical improvement, the patient succumbed to ventilator-associated pneumonia after 20 days of hospitalization. This rare case underscores the critical importance of early diagnosis and a multidisciplinary approach, including tailored nutritional therapy, for optimizing outcomes in patients with combined empyema and chylothorax.