CC BY 4.0 · Surg J (N Y) 2019; 05(02): e57-e61
DOI: 10.1055/s-0039-1693653
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Actinomyces Meyeri Empyema Necessitatis—A Case Report and Review of the Literature

David B. Ellebrecht
1  Department of Surgery, University Medical Center Schleswig-Holstein, Luebeck, Germany
,
Moritz M.F. Pross
2  Department of Orthopedics and Trauma Surgery, Robert Bosch Hospital, Stuttgart, Germany
,
Stefanie Schierholz
1  Department of Surgery, University Medical Center Schleswig-Holstein, Luebeck, Germany
,
Emanuel Palade
1  Department of Surgery, University Medical Center Schleswig-Holstein, Luebeck, Germany
› Author Affiliations
Further Information

Publication History

04 April 2018

28 May 2019

Publication Date:
16 July 2019 (online)

  

Abstract

Pleural empyema necessitatis caused by Actinomyces meyeri is a rare but severe infection. A. species predominantly A. meyeri and A. israelii represent the second most common pathogen for empyema necessitans after mycobacteria. The incidence is reported in the literature to be 1:300,000. Men are thrice more likely to be affected than women. Pathogenetically, an infection can be triggered by aspiration in immunocompromised individuals which leads to an atelectasis with pneumonitis.

In two cases, a 38-year-old construction worker and a 61-year-old woman with ulcerative breast carcinoma, who presented to the local emergency department with a painful swelling of the left chest, diagnostic workup revealed a pleural empyema necessitatis of the left chest. An antibiotic treatment was initiated with piperacillin/tazobactam and sulbactam/ampicillin, respectively. Temporally vacuum-dressing therapy was initiated after surgical debridement. In the course of the procedure, a reconstruction of tissue damage was feasible. The patients were recovered completely and discharged with an oral antibiotic treatment (amoxicillin) for 6 and 12 months, respectively.

Thoracic actinomycosis is a relatively uncommon and traditionally chronic, indolent infection secondary to pulmonary infection with A. species. Surgical treatment is generally reserved for cases failing to resolve with antibiotic therapy. Early diagnosis, prompt debridement, and narrow spectrum β-lactam antibiotics can result in complete resolution of infection and good prognosis.