Bukamur Hazim, Ahmed Waseem, Numan Yazan, Shahoub Ibrahim, Zeid Fuad
Department of Pulmonary Medicine, Joan C. Edwards School of Medicine, Marshall University, Huntington, WV, USA.
Case Rep Infect Dis. 2018 Feb 18;2018:8039803. doi: 10.1155/2018/8039803. eCollection 2018.
Empyema thoracis is a serious condition characterized by the accumulation of purulent fluid in the pleural cavity, typically following a pneumonia, subdiaphragmatic abscess, or esophageal rupture. Fungal empyema thoracis is a rare form of this condition with especially high mortality, in which the most frequently isolated fungus is spp. This article presents a 74-year-old female with pneumonia and a complicated hospital course, initially presenting with nausea, vomiting, and dysphagia. She was initially suspected to have community-acquired pneumonia and was started on azithromycin and ceftriaxone. Worsening respiratory function led to the diagnosis of hydropneumothorax. Pleural fluid and an independent sample of pus and pleural tissue grew , giving the diagnosis of fungal empyema. With further respiratory deterioration, the patient was intubated and switched to piperacillin/tazobactam and micafungin. Decortication with extensive pleural peel and removal of foul-smelling pus and food particles within the chest was performed. This further lead to confirmation of esophageal perforation, and she was started on voriconazole and meropenem. After developing septic shock, the patient was managed with phenylephrine and vasopressin. Finally, after improving she was weaned off pressors and extubated, followed by an esophagogastroduodenoscopy (EDG) with pneumatic balloon dilation and WallFlex stent placement. This patient's case demonstrated an example of empyema thoracis, which required a high index of suspicion since the presentation was with a community-acquired infection. empyema thoracis may be a complication of operation, gastroesophageal fistula, and spontaneous esophageal rupture. On the other hand, the course of this patient's hospital stay progressed from esophageal perforation to pneumonia, empyema, and pneumothorax. Thus, community-acquired fungal empyema should be considered in patients with respiratory symptoms and suspected esophageal perforation; nevertheless, after a diagnosis of fungal empyema, esophageal perforation should also be ruled out in addition to other causes like pneumonia, subphrenic abscess, and hematogenous spread. Improved communication between clinicians and microbiologists can lead to early diagnosis and a reduction in the morbidity and mortality of this condition.
脓胸是一种严重病症，其特征为胸膜腔内积聚脓性液体，通常继发于肺炎、膈下脓肿或食管破裂。真菌性脓胸是这种病症的一种罕见形式，死亡率特别高，其中最常分离出的真菌是 spp。本文介绍了一名 74 岁女性，患有肺炎且病程复杂，最初表现为恶心、呕吐和吞咽困难。她最初被怀疑患有社区获得性肺炎，并开始使用阿奇霉素和头孢曲松治疗。呼吸功能恶化导致诊断为液气胸。胸腔积液以及独立的脓液和胸膜组织样本培养出 ，从而诊断为真菌性脓胸。随着呼吸功能进一步恶化，患者接受了插管，并改用哌拉西林/他唑巴坦和米卡芬净治疗。进行了广泛胸膜剥脱的胸膜纤维板剥脱术，并清除了胸腔内有恶臭的脓液和食物颗粒。这进一步证实了食管穿孔，随后她开始使用伏立康唑和美罗培南治疗。在发生感染性休克后，患者使用去氧肾上腺素和血管加压素进行治疗。最后，在病情好转后，她停用了升压药并拔除了气管插管，随后进行了食管胃十二指肠镜检查（EDG），并置入了气囊扩张器和 WallFlex 支架。该患者的病例展示了脓胸的一个实例，由于其表现为社区获得性感染，因此需要高度怀疑。 脓胸可能是手术、胃食管瘘和自发性食管破裂的并发症。另一方面，该患者的住院病程从食管穿孔发展为 肺炎、脓胸和气胸。因此，对于有呼吸道症状且怀疑食管穿孔的患者，应考虑社区获得性真菌性脓胸；然而，在诊断为真菌性脓胸后，除了肺炎、膈下脓肿和血行播散等其他原因外，还应排除食管穿孔。临床医生和微生物学家之间加强沟通可实现早期诊断，并降低这种病症的发病率和死亡率。
