A rare complication of pleural drainage: Communicating lung and subcutaneous abscesses

Pleural drainage is a key element in the management of parapneumonic effusions. Although generally safe, rare complications may occur. We report a case of a 79-year-old male, admitted with a community-acquired pneumonia and a left-sided complex parapneumonic effusion requiring drainage. Initial treatment with antibiotics and drainage resulted in clinical improvement, and the patient was discharged. Seven weeks later, the patient was re-admitted with clinical deterioration. Imaging revealed a large lung abscess communication with a subcutaneous abscess through a pleurocutaneous fistula at the previous catheter insertion site. Despite transient complications, including hemoptysis during catheter flushing, the patient improved clinically. The subcutaneous abscess resolved without direct intervention, and follow-up imaging demonstrated gradual regression of the lung abscess. This case describes a rare but clinically significant complication of pleural drainage, resulting in fistula formation and dual abscess development. Furthermore, it illustrates that conservative management with targeted drainage and antibiotics may be effective even in complex presentations.