Pleural infection as a complication of ascending urological infection is rare, and the mechanism often unclear. We report a complicated case of pleural infection and perinephric abscess in a patient who presented with a large right‐sided pleural effusion. Pleural fluid culture yielded Morganella morganii, an unusual pathogen in pleuro‐pulmonary infections. Her computed tomography (CT) scan of abdomen showed a right perinephric abscess which extended into the pleural cavity. Review of prior CT imaging suggested a pre‐existing diaphragmatic defect, likely representing a congenital Bochdalek foramen, through which the infection ascended. Successful treatment was achieved with systemic antibiotics, and drainage of both the pleural and retroperitoneal collections. Intra‐pleural tissue plasminogen activator/deoxyribonuclease therapy effectively cleared the residual pleural fluid. Spread of intra‐abdominal sepsis through diaphragmatic defects to the pleural cavity represents a potential source of empyema.
With over 150 species, non‐tuberculous mycobacteria are increasingly recognized to be important human pathogens that pose diagnostic and management challenges. We report a rare case of cervical lymphadenitis and pulmonary disease caused by Mycobacterium paraffinicum in a 64‐year‐old man who presented with three‐month history of increasing right‐sided painless neck lump. His medical history included rheumatoid arthritis, which was managed with leflunomide and methotrexate. Computed tomography scans of his neck and thorax revealed a right lower neck and supraclavicular fossa cystic mass with peripheral enhancement and bilateral multiple small pulmonary nodules. M. paraffinicum was cultured from a fine‐needle aspiration of the mass. Two out of three sputa were acid‐fast bacilli smear positive but cultures did not yield any viable organism. He developed spontaneous discharge of purulent material via a sinus, which drained over two months and recovered with a completely healed sinus without any further treatment.
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