Recurrent spontaneous bacterial empyema in cirrhosis: a case report

Spontaneous bacterial empyema occurs in about 0.4% of cirrhotic patients, but recurrent attack has rarely been reported. Herein we report a case of repeat episodes of spontaneous bacterial empyema. The patient presented with fever, shortness of breath and three episodes of spontaneous bacterial empyema (accompanied by septic shock in two episodes) within six months. Chest roentgenography showed massive right-side pleural effusion. Thoracentesis yielded pleural effusion containing a neutrophil count of more than 500/microliter. A blood culture grew non-O1 Vibrio cholerae in one episode and the pleural effusion culture grew Aeromonas hydrophila. A chest-tube was inserted during the latest episode due to a low pH and glucose concentration in the pleural fluid. The patient recovered well after medical treatment. The etiology, diagnosis and management of spontaneous bacterial empyema are discussed.