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Fungal empyema is an uncommon condition associated with high morbidity and mortality.  Aspergillus  empyema thoracis is rare and is usually associated with preexisting chronic empyema, pulmonary tuberculosis, or rupture of aspergilloma cavity. This case describes a healthy 20-year-old man presenting with chronic intractable back pain and constitutional symptoms for 6 months who was eventually diagnosed with  Aspergillus  empyema thoracis, complicated by empyema necessitans extending into multiple ribs and paravertebral areas. He was treated with surgical decortication, chest tube drainage, and systemic antifungal agents. The diagnostic difficulties of fungal empyema thoracis are highlighted.

Empyema necessitans as a rare manifestation of Aspergillus fumigatus infection