BILATERAL THORACIC EMPYEMA DUE TO TWO TYPES OF PNEUMONIA SIMULTANEOUSLY

Empyema thoracis is a common complication of infectious diseases and is an important cause of morbidity and hospital admissions. Clinical presentation is usually unilateral but some (rare) bilateral cases have been reported. We describe a 38-year-old Hispanic male who was a heavy consumer of alcohol admitted to hospital with cough, green sputum, dyspnea, chest pain and fever of 2-week duration. Physical examination revealed a right pleural effusion. A chest tube was used to drain 1100 cm3 of yellow, thick turbid fluid, and levofloxacin and clindamycin were initiated via the intravenous route in the emergency room. In spite of prompt improvement, he developed pyrexia and dyspnea again. A new alveolar opacity on the left hemithorax was observed and imipenem was started. Despite clinical improvement, computed tomography 5 days thereafter demonstrated bilateral loculated pleural effusions. Thoracic surgeons undertook a thoracotomy with pleural decortication in the right hemithorax, and the left pleural effusion was managed with a chest tube. Cultures of pleural fluid from the right empyema were negative. However, the nosocomial bacterium Corynebacterium urealyticum was detected in cultures of pleural fluid from the left empyema. The importance of this case is that the patient developed hospital-acquired pneumonia in the left lung after he had developed community-acquired pneumonia in the right lung, and both cases of pneumonia developed loculated empyema. To our knowledge, this situation has not been reported previously. The patient was managed bilaterally simultaneously with good results.