Chest Infections: Chest Infections |

A Peculiar Aspergillus Empyema Treated With Medical Thoracoscopy FREE TO VIEW

Qing-Hua Liu, MD; Bing Li, MD; Yun-Yan Wan, MD; Zhou-Hong Yao, MD; Dian-Jie Lin, MD
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Shandong Provincial Hospital Affiliated to Shandong University, Jinan, China

Copyright 2016, American College of Chest Physicians. All Rights Reserved.

Chest. 2016;149(4_S):A69. doi:10.1016/j.chest.2016.02.074
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SESSION TITLE: Chest Infections

SESSION TYPE: Case Report Slide

PRESENTED ON: Sunday, April 17, 2016 at 09:45 AM - 11:15 AM

INTRODUCTION: Aspergillus empyma thoracis is an uncommon but potentially life-threatening entity with unsatisfied outcome [1]. Here we report a peculiar case of aspergillus empyema and successfully treated with medical thoracoscopy.

CASE PRESENTATION: A 42-year-old male presented with complaints of high fever and breathlessness for one month. He was previously hospitalized and treated at local medical institute and diagnosed as infection of left lung cyst. Being unsatisfied with the outcome of medical treatment, a wedge resection of the left upper lobe was performed and a Y-type chest tube was placed for fluid drainage. The pathology yield of resection tissue only suggests inflammation of cyst and bleb. His temperature is not improved with broad-spectrum antibiotics. His pleural fluid yield culture suggested aspergillus, and then systemic voriconazole was prescribed. Breathlessness didn’t relieve with 10 days anti-aspergillus therapy. Chest X-ray suggests right pleural effusion and infection. Rigid medical thoracoscopy was performed (Fig 1). The patient was treated by continuous intravenous voriconazole and flush of chest cavity with voriconazole one times a day after procedure. Result of culture also proves aspergrillus empyema thoracis (Fig 2). Four days later symptom improved greatly. Flush of chest cavity with voriconazole last 6 weeks while administration of oral voriconazole last 4 months. No side effect was detected. Followed-up till 8 months, the patient keeps well and only light pleura thickening was found.

DISCUSSION: The incidence of aspergillus pleural empyema thoracis is often correlated with the host impaired denfense, pyopneumothorax or chronic lung lesions as bronchiectatic cavities or tuberculosis sequelae[2]. This current patient history of lobecomy for a bleb and cyst infection and, didn’t have a satisfied response of broad spectrum antibiotic therapy but later the etiology confirmed. Prompt rigid medical thoracoscopy to clean the necrotic material in pleural cavity plays a vital role for successful treatment of aspergillus thoracis. Secondly systemically or locally used of anti-fungal as voriconazole, a potentially safe, effective first-line drugs with minimum probability of resistance to aspergillus fumigatus, is another important factor[3]. Thirdly drainage and wash pleural cavity every day is also very important.

CONCLUSIONS: The rigid medical thoracoscopy interventions, systematically and locally anti-fungi as well as drainage which are all important factors to improve the outcome aspergillus empyema.

Reference #1: Ko, S. C., et al., Fungal empyema thoracis: an emerging clinical entity. Chest, 2000. 117(6): p. 1672-8.

Reference #2: Zhang, W., et al., Pleural aspergillosis complicated by recurrent pneumothorax: a case report. J Med Case Rep, 2010. 4: p. 180.

Reference #3: Walsh, T. J., et al., Treatment of aspergillosis: clinical practice guidelines of the Infectious Diseases Society of America. Clin Infect Dis, 2008. 46(3): p. 327-60.

DISCLOSURE: The following authors have nothing to disclose: Qing-Hua Liu, Bing Li, Yun-Yan Wan, Zhou-Hong Yao, Dian-Jie Lin

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