Refractory Spontaneous Bacterial Empyema in Cirrhotic Patient

Spontaneous bacterial empyema (SBEM), also called spontaneous bacterial pleuritis, is an infection of the pleural space that arises in the setting of cirrhosis and, by definition, the absence of pneumonia. It is likely underdiagnosed as its symptoms are nonspecific and it lacks standardized diagnost...

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Bibliographic Details
Published in:Case reports in gastrointestinal medicine 2021-07, Vol.2021, p.1-5
Main Authors: Chow, Erica, Khiatah, Bashar, Frugoli, Amanda
Format: Article
Language:English
Subjects:
Abdomen
Alcohol
Antibiotics
Ascites
Bacterial pneumonia
Blood
Cancer
Care and treatment
Case Report
Case reports
Empyema
Health aspects
Hernias
Infections
Infectious diseases
Liver
Liver cirrhosis
Metronidazole
Mortality
Neutrophils
Pain
Pathogenesis
Patients
Phosphatase
Pleural effusion
Pneumonia
Proteins
Sepsis
Thoracentesis
Ultrasonic imaging
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Summary:Spontaneous bacterial empyema (SBEM), also called spontaneous bacterial pleuritis, is an infection of the pleural space that arises in the setting of cirrhosis and, by definition, the absence of pneumonia. It is likely underdiagnosed as its symptoms are nonspecific and it lacks standardized diagnostic and therapeutic recommendations. SBEM represents a distinct complication of hepatic hydrothorax with different pathogenesis, presentation, and treatment strategy from those of empyema secondary to pneumonia. Surprisingly, nearly 40% of episodes of spontaneous empyema are not associated with spontaneous bacterial peritonitis. Although SBEM is amenable to prompt antibiotic therapy, it has a high rate of mortality and morbidity. A high clinical suspicion is crucial for patient survival and timely initiation of appropriate antibiotics. Increased understanding, recognition, and standardization of treatment would help alleviate the relatively high burden of SBEM. In this case vignette, we provide a review of the relevant literature, and we describe a rare case of SBEM in a patient with a history of alcohol-associated liver cirrhosis and prior episode of spontaneous bacterial peritonitis (SBP). SBEM was diagnosed with thoracentesis and analysis of the aspirate, and he was treated with ceftriaxone with resolution of his presenting abdominal pain and leukocytosis.
ISSN:2090-6528
2090-6536
DOI:10.1155/2021/6685998