Rare pulmonary presentation: empyema necessitans

Pulmonary actinomycosis is a rare cause of granulomatous and suppurative lung disease that often presents with non-specific symptoms leading to misdiagnosis or delayed diagnosis. Complications include sepsis, infective endocarditis and rarely empyema necessitans. In our report, we present a case of a gentleman in his late 50s, with poor oral hygiene and a number of other risk factors who presented with severe weight loss and an expanding chest wall mass. Following a thorough physical examination and biochemical, radiological and microbiological investigations, the patient was diagnosed with an empyema necessitans secondary to pulmonary actinomycosis. The patient was eventually treated successfully with a prolonged course of antibiotics and did not require surgical intervention. Pulmonary actinomycosis has decreased drastically in incidence and the presence of such severe clinical presentations have become even rarer, thanks to the early introduction of antimicrobial agents.