Tuberc Respir Dis.  2014 Aug;77(2):94-97. 10.4046/trd.2014.77.2.94.

Empyema Necessitatis in a Patient on Peritoneal Dialysis

• Moh IH
• Lee YK
• Kim HJ
• Jung HY
• Park JH
• Ahn HK
• Noh JW

• KMID: 2320546
• DOI: http://doi.org/10.4046/trd.2014.77.2.94

Abstract

Empyema necessitatis is a rare complication of an empyema. Although the incidence is thought to be decreased in the post-antibiotic era, immunocompromised patients such as patients with chronic kidney disease on dialysis are still at a higher risk. A 56-year-old woman on peritoneal dialysis presented with an enlarging mass on the right anterior chest wall. The chest computed tomography scan revealed an empyema necessitatis and the histopathologic findings revealed a granulomatous inflammation with caseation necrosis. The patient was treated with anti-tuberculous medication.

Keyword

Empyema; Mycobacterium tuberculosis; Peritoneal Dialysis

MeSH Terms

Dialysis
Empyema*
Female
Humans
Immunocompromised Host
Incidence
Inflammation
Middle Aged
Mycobacterium tuberculosis
Necrosis
Peritoneal Dialysis*
Renal Insufficiency, Chronic
Thoracic Wall
Thorax

Figure

• 

  Figure 1 Skin lesions. Pink erythematous, cold, soft, tender subcutaneous mass of 6×3 cm size are noted on the right chest wall between the fifth and seventh ribs.

• 

  Figure 2 The initial chest X-ray reveals a pleural thickening in the right lung.

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  Figure 3 (A, B) On admission, the chest computed tomography (CT) reveals a calcified pleural thickening with loculated fluid collection in the right lower anterior hemithorax (arrowhead) and with multiple cystic extrapleural masses in right anterior chest wall (arrows). (C, D) After 5 months of therapy, the chest CT reveals a reduced loculated fluid collection in the right lower anterior hemithorax (arrowhead) and a reduced size of the multiple cystic extrapleural masses in the right anterior chest wall (arrows).

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  Figure 4 A needle biopsy of the right anterior chest wall shows a caseogranulomatous inflammation, consistent with tuberculosis (H&E stain, ×200).

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