Empyema Necessitatis: Unique Presentation in a Coccidioidomycosis Case

Empyema necessitans and a persistent air leak associated with rupture of an anaerobic lung abscess due to bacteroides

“…This misdiagnosis led directly to the left pleural space being incorrectly identified as the likely source of the air leak, delaying definitive (right-sided) pleural intervention. The left-sided pneumothorax and the pneumomediastium were probably caused by pressurised air tracking from the leaking right lower lobe through the pulmonary ligament and/or directly into the mediastinum via additional parietal pleural defects not visible on CT. Third, the pathogen identified in this case ( Bacteroides ) is a relatively uncommon cause of EN, which is most frequently caused by Mycobacterium tuberculosis and less commonly by Actinomyces israelii, Staphylococcus aureus, Streptococcus milleri, Mycobacterium avium-intracellulare and Aspergillus fumigatus 4. However, Bacteroides is a common cause of intrapulmonary abscess and pleural infection, which were the primary disease mechanisms here 5.…”

A Rapidly Expanding Chest Wall Mass in an Adolescent With COVID-19

“…[3][4][5][6][7] These etiologies include the endemic mycoses histoplasmosis, blastomycosis, and coccidioidomycosis. 4 Less common etiologies can include parasitic infections such as Paragonimus westermani. 5 Empyema necessitans can also be a complication of poor dental health, including periodontitis.…”

“…1 The infectious etiology most classically associated with this diagnosis is Mycobacterium tuberculosis , 2 although many pathogens have been described (Table 1). 3-7 These etiologies include the endemic mycoses histoplasmosis, blastomycosis, and coccidioidomycosis. 4 Less common etiologies can include parasitic infections such as Paragonimus westermani .…”

Delayed post‐pneumonectomy empyema necessitans caused by Aspergillus flavus: An unusual report

“…In severe cases, discharge may be externalized 10 . The most likely pathogen for empyema necessitans is Mycobacterium tuberculosis , and less commonly are Nocardia , Actinomyces and Aspergillus species 11,12 …”

“…10 The most likely pathogen for empyema necessitans is Mycobacterium tuberculosis, and less commonly are Nocardia, Actinomyces and Aspergillus species. 11,12 There are some reports on the spontaneous empyema necessitans caused by Aspergillus species and, on the other hand, there are very few cases of post-pneumonectomy Aspergillus pleural empyema necessitans.…”