Department of Dermatology, Hospital Universitario de la Princesa, CP 28006, Madrid, Spain.
Eur J Dermatol. 2010 Jan-Feb;20(1):115-9. doi: 10.1684/ejd.2010.0809. Epub 2009 Oct 12.
Empyema necessitatis (EN) is a rare disease, with unknown incidence, which has received little attention from a dermatological point of view but it is essential to recognize it because of the possibility of causing mortality if not treated properly and in time. We report a 32-year-old woman, diagnosed with nervous anorexia, with an enlarging mass on the anterior right thoracic wall. Cultures showed Actinomyces gerencseriae as the main etiological agent of her empyema "necessitatis". She was successfully treated with amoxicillin with clavulanic acid. We found that 1) M. tuberculosis (35%) is still the most frequent agent, but Actinomyces (25%) and MRSA (10%) are becoming more relevant; 2) the most frequent dermatological finding is a subacute erythematous mass on costal wall; 3) new treatments have lowered mortality. Any enlarging and painful subacute thoracic mass with fluctuation should be considered as an EN suspicious lesion and the diagnostic approach must include a chest X-ray to rule out lung infection. Dermatologists should know about this infrequent entity in order to properly identify the potentially life-threatening process under these cutaneous lesions, achieving an early diagnosis and proper treatment.
脓性胸腔积液（EN）是一种罕见疾病，其发病率未知，从皮肤科角度来看，该病关注度较低，但由于如果不及时进行适当治疗，可能会导致死亡，因此认识该病非常重要。我们报告了一位 32 岁的女性，患有神经性厌食症，在前右胸壁上有一个增大的肿块。培养显示，A.gerencseriae 是导致她脓性胸腔积液“必要”的主要病因。她成功地接受了阿莫西林克拉维酸治疗。我们发现：1）结核分枝杆菌（35%）仍然是最常见的病原体，但放线菌（25%）和耐甲氧西林金黄色葡萄球菌（MRSA）（10%）变得更加相关；2）最常见的皮肤科发现是肋壁亚急性红斑性肿块；3）新的治疗方法降低了死亡率。任何增大的、疼痛的亚急性胸痛，伴有波动感，都应被视为脓性胸腔积液可疑病变，诊断方法必须包括胸部 X 光检查，以排除肺部感染。皮肤科医生应该了解这种罕见的疾病，以便能够正确识别这些皮肤病变下可能危及生命的过程，实现早期诊断和适当治疗。
