A Case of Empyema Caused by a Spread of Pyogenic Spondylitis that was Inferred from Intraoperative Findings

Abstract

A 76-year-old man who had a previous history of bladder cancer and had been under treatment for diabetes mellitus presented to our hospital with right-sided chest pain, posterior neck pain, and fever. Following close examination, right pleuritis and cervical abscess were suspected, and he was admitted to the hospital. Blood tests on admission showed an elevated inflammatory response, and blood cultures were positive for MRSA. On the 6th day, despite antibiotic therapy, he was diagnosed with pyothorax due to increased pleural effusion on imaging and thoracic cavity drainage was performed. On the 8th day, thoracoscopic curettage of pyothorax was performed. There was an abscess cavity in the right anterior aspect of the 6th and 7th thoracic vertebrae which could not be identified before surgery, suggesting thoracic perforation of pyogenic spondylitis. Postoperative inflammatory response tended to improve, and the patient was discharged on postoperative day 15.

There are few reports of acute empyema caused by thoracic perforation associated with pyogenic spondylitis. In this case, the abscess cavity in the anterior aspect of the thoracic vertebrae was confirmed by early imaging findings, suggesting that inflammation from pyogenic spondylitis might have spread and perforated into the thoracic cavity. Drainage is important in treatment of acute pyothorax, and surgery that allows effective drainage may contribute to early healing.