Empyema, acute respiratory failure, and septic shock after aspiration of a soft-shelled turtle (Pelodiscus sinensis) bone by an adult

Abstract

IntroductionThe common late complications of foreign body aspiration include granulation formation, obstructive pneumonia, and atelectasis. However, a foreign body-induced pleural infection is very rare, and especially when it is not iatrogenic.Case descriptionA 64-year-old Chinese man was admitted to our hospital with septic shock and acute respiratory failure requiring intubation and mechanical ventilation. Computed tomography revealed multiloculated pleural effusion on the whole right side and right lung atelectasis, with enhanced thickening and calcification of pleura and a foreign body in the right intermediate bronchus. The effusion appeared as a cloudy fluid consistent with pus. A bedside bronchoscopy revealed an irregular foreign body lodged in the right intermediate bronchus. The hard bone was removed and confirmed to be a soft-shelled turtle bone. A final diagnosis of foreign body-induced empyema, acute respiratory failure, and septic shock was confirmed. The patient showed good recovery after completing a course of broad-spectrum antibiotics and undergoing chest tube drainage.Discussion and evaluationAlthough empyema has been reported previously as a rare complication of long-term retention of an aspirated foreign body, no case has been observed that was as serious as our current patient. In addition, a foreign body aspiration by a soft-shelled turtle bone was never reported before.ConclusionsFor the first time, we describe the successful treatment of an adult patient presenting with empyema, accompanied by serious conditions of acute respiratory failure and septic shock induced by aspiration of a soft-shelled turtle bone. Clinicians should consider the possibility of non-iatrogenic foreign body-induced empyema with acute onset of respiratory failure, when a patient’s symptoms cannot be attributed to an alternative obvious cause.

Empyema associated with vegetable foreign body aspiration

“…Although rare, post-obstructive pneumonitis, as a consequence of AFBs, with secondary empyema has been reported. [1][2][3][4] The mechanisms of non-iatrogenic AFB-induced empyema are poorly understood; one main mechanism is post-obstructive pneumonia caused by foreign body aspiration. Vegetable foreign bodies, such as pepper and peanuts, are most likely to cause granulation.…”

“…Empyema caused by foreign body aspiration in adults is extremely rare, and relevant cases have been rarely reported. [1][2][3][4] Certain types of foreign bodies, such as vegetables, are not visible on computed tomography (CT) scans, and this can lead to misdiagnosis. Herein, we described the successful treatment of an adult patient who presented with severe empyema following occult vegetable aspiration.…”

Empyema thoracis complicated by anaemia as caused by occult bonelet aspiration

“…Although empyema has been previously reported as a rare complication involving the long-term retention of an aspirated FB [2], an FBA due to a fragmented bonelet has never been reported on before [2]. Prolonged retention of the FB can cause an inflammatory reaction in the surrounding mucosa, sometimes being mistaken for a carcinoma [1].…”

“…Post-obstructive pneumonitis as a consequence of foreign body (FB) aspiration (FBA) with secondary empyema is a rare condition, but still well reported upon [1]. Post-obstructive pneumonia is the main mechanism by which FBA causes empyema [2]. The culture results of pleural fluid caused by an FB-induced pleural empyema can come back as either an anaerobic agent (e.g.…”

“…Campylobacter) or as negative. This may be explained by the possible anaerobic environment created by direct obstruction from an FB and/or the formation of a granuloma induced by chronic inflammation [2]. We have described the successful treatment of an adult patient who was presented at our hospital with the serious condition of empyema complicated by anaemia due to occult bonelet aspiration.…”