Open AccessSpontaneous bacterial empyema: an elusive diagnosis in a patient with cirrhosis
Author(s) -
Sarthak Soin,
Nehan Sher,
Nasir Saleem
Publication year - 2018
Publication title -
bmj case reports
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.231
H-Index - 26
ISSN - 1757-790X
DOI - 10.1136/bcr-2018-224810
Subject(s) - medicine , empyema , pleural effusion , cirrhosis , spontaneous bacterial peritonitis , chills , hydrothorax , malignancy , complication , pleurisy , pleural disease , effusion , surgery , gastroenterology , ascites , respiratory disease , lung
Hepatic hydrothorax refers to the presence of a pleural effusion (usually >500 mL) in a patient with cirrhosis in whom other causes of pleural effusion, such as cardiopulmonary causes, pleural disease or malignancy have been excluded. It is seen in 5%-10% of patients with end-stage liver disease. A subset of these patients can develop infection of the hepatic hydrothorax, called spontaneous bacterial empyema. They may present with fever, chills and dyspnoea. We present the case of an 83-year-old man with a history of cirrhosis who developed a large right-sided pleural effusion, confirmed to be empyema by pleural fluid analysis. We aim to highlight the occurrence of spontaneous bacterial empyema. While less common that spontaneous bacterial peritonitis as a complication of cirrhosis, it is equally serious with potential for adverse outcomes.