Successful Surgical Treatment in Empyema Caused by an Atypical Pathogen: Non-typhoid Salmonella

Empyema is most often associated with bacterial pneumonia, with Streptococcus pneumoniae being the predominant pathogen. Salmonella species are a rare cause of pleural empyema, typically occurring in immunocompromised individuals. We report a case of Salmonella enteritidis empyema in a 16-year-old male with a history of bronchial asthma but no other known risk factors. The patient presented with a 10-day history of right-sided pleuritic chest pain, fever, and dyspnea. Imaging revealed a complex right-sided pleural effusion with an air-fluid level. Initial thoracentesis was unsuccessful, and a chest tube drained hematopurulent fluid. Despite broad-spectrum antibiotics, clinical response was inadequate, prompting surgical intervention. Due to intraoperative bronchospasm, video-assisted thoracoscopic surgery was converted to open thoracotomy with pleurectomy. Cultures from the pleural fluid identified S. enteritidis. The patient recovered well and was discharged on oral antibiotics. Follow-up confirmed full clinical and radiological resolution. This case highlights the need to consider Salmonella as a potential cause of empyema even in immunocompetent adolescents. Early surgical intervention may be essential in refractory cases. Asthma, although not classically immunosuppressive, may predispose patients to invasive infections and warrants further investigation as a potential risk factor.