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Infections
Recurrent empyema due to Salmonella enteritidis in a patient on hemodialysis
Author(s) -
Hung Y.M.,
Chou K.J.,
Chung H.M
Publication year - 2005
Publication title -
hemodialysis international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.658
H-Index - 47
eISSN - 1542-4758
pISSN - 1492-7535
DOI - 10.1111/j.1492-7535.2005.1121ah.x
Subject(s) - medicine , empyema , hemodialysis , salmonella enteritidis , pleural effusion , surgery , thoracentesis , bacteremia , ceftriaxone , pericardial window , pericardial effusion , salmonella , antibiotics , biology , bacteria , microbiology and biotechnology , genetics
Objective: Pleural involvement of salmonella infection is very rare and we are not aware of any case of salmonella empyema in hemodialysis patients. The purpose of this study is to report our experience of recurrent empyema due to Salmonella enteritidis with bacteremia in a patient on hemodialysis. Case report: A 53‐year‐old woman with end stage renal disease, having been on hemodialysis for 10 days, was brought to the emergency department due to fever and shortness of breath for 2 days. Her initial physical examination revealed diminished breathing sound over right lung field. The chest radiographs disclosed right pleural effusion and pleural fluid analysis included a white cell count of 13800(N/L:95/5), LDH 2534 U/L, protein 2.7 g/dL, and sugar 10 mg/dL. Right side empyema was noted. Sonography revealed splenomegaly . Salmonella enteritidis was identified from the cultures of blood and pleural fluid. After antimicrobial therapy with intravenous ceftriaxone for 2 weeks and pleural pigtail drainage, fever subsided and pleural drainage tube was removed. However, thoracoscopic debridement was done later because of recurrent empyema within one week after removing the drainage tube. Computed tomography revealed pleural effusion, pericardial effusion, and splenomegaly, but there was no evidence of aortic aneurysm formation or infectious process of aorta. Overall the patient received 6 weeks of intravenous ceftriaxone treatment and 3 months of oral ciprofloxacin. The follow‐up CXR revealed minimal pleural effusion. Conclusion: Nontyphoidal salmonella infection can present with empyema and bacteremia in patients on hemodialysis. Adequate drainage and antimicrobial therapy may be necessary to treat such patients effectively.