A case report on intrapleural administration of antibiotic in tuberculous empyema

Authors

  • Aditya S. Bhushan Department of Pulmonary Medicine, BMCRI, Bangalore, Karnataka, India
  • Shashi Bhushan B. L. Department of Pulmonary Medicine, BMCRI, Bangalore, Karnataka, India
  • Anupama R. Department of Pulmonary Medicine, BMCRI, Bangalore, Karnataka, India

DOI:

https://doi.org/10.18203/2349-3933.ijam20233574

Keywords:

Tubercular empyema, Fiber optic bronchoscopy, Streptomycin, Intercostal drain, Intrapleural administration

Abstract

A 34-year-old male came with complaints of cough with copious yellowish expectoration, hemoptysis, difficulty in breathing and constitutional symptoms like fever, loss of weight and anorexia. Contrast enhanced computed tomography was done which showed left sided empyema likely secondary to rupture of left upper lobe lung abscess. The case was proceeded with fiber-optic bronchoscopy and bronchoalveolar lavage which showed narrowed bronchial openings on both sides. BAL analysis showed total cell count of 1500 cells/mm3 with 70% neutrophils, 5% lymphocytes and 25% of epithelial cells and macrophages. Culture showed Klebsiella species and antibiotics were escalated according to sensitivity pattern. Intercostal drain with under water seal was inserted on left side and thick pus was drained and sent for analysis. Anti-tubercular treatment was started. Due to persistent drainage of pus, intra pleural administration of Streptomycin was done for 30 days. Patient was monitored with serial chest X-rays and relevant blood investigations. Good clinicoradiological resolution was noted.

References

Light RW. Pleural diseases. Sixth Edition. Lippincott Williams and Wilkins. 2013.

Grippi MA, Antin-Ozerkis DE, Cruz CSD, Kotloff R, Kotton CN, Pack AI, et al. Fishman’s Pulmonary Diseases and Disorders. Sixth edition. McGraw Hill / Medical. 2022.

Sahn SA, Iseman MD. Tuberculous empyema. Semin Respir Infect. 1999;14(1):82-7.

Khaled M. Al-Kattan. Management of tuberculous empyema. Eur J Cardiothorac Surg. 2000;17(3):251-4.

Long R, Barrie J, Stewart K, Peloquin CA. Treatment of a tuberculous empyema with simultaneous oral and intrapleural antituberculosis drugs. Can Respir J. 2008;15(5):241-3.

Neihart RE, Hof DG. Successful nonsurgical treatment of tuberculous empyema in an irreducible pleural space. Chest. 1985;88:792-4.

Elliott AM, Berning SE, Iseman MD, Peloquin CA. Failure of drug penetration and acquisition of drug resistance in chronic tuberculous empyema. Tuber Lung Dis. 1995;76:463-7.

Nie Q, Tao LX, Tu SJ, Wei Y, Yao G, Li CH, et al. Treatment of chronic tuberculous empyema by intrapleural injection of anhydrous ethanol. Respir Med Case Rep. 2019;26:35-8.

Uraizee AR, Memon JA, Bhagwani AR, Poonawala AA, Farhan IA, Husain SA. Tuberculous empyema thoracis surgical perspective. Eur Respir J. 2011;38:53.

Bai KJ, Wu IH, Yu MC, Chiang IH, Chiang CY, Lin TP, et al. Tuberculous empyema. Respirology. 1998;3(4):261-6.

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Published

2023-11-24

Issue

Section

Case Reports