engleski

Septic shock caused by pleural empyema: diagnostic and therapeutic approach

Introduction: Pleural empyema pertains to the presence of purulent contents in the pleural space, usually after infections or thoracic trauma. A septic shock is not a common presentation of empyema. Case description: A 53-year-old patient was admitted to the intensive care unit (ICU) with septic shock and acute respiratory failure requiring intubation and mechanical ventilation. Anamnestic data revealed the right chest traumafive days ago. During the initial examination in the emergency room, the patient complained of an inability to breathe and chest pain and a chest radiograph showed large right-sided pleural effusion.Computed tomography (CT) revealed extensive pleural effusion on the right side. Chest tube drainage was performed, and the effusion appeared as a cloudy fluid consistent with pus. Due to the septic shock he was treated with volume replacement, continuous noradrenalin and vasopressin infusion, whereas mechanical ventilation using high oxygen concentration was used. The meropenem and linezolid for ten days followed with azithromycin for three days were given, even though blood cultures, tracheal aspirate, pleural effusion and urine were negative. This treatment allowed discontinuation of vasopressors and resulted in the decrease of both CRP and procalcitonin levels. On the seventeenth ICU day bronchoscopic specimens yielded Stenotrophomonas maltophilia and according to the antibiogram treatment with trimethoprim and sulfamethoxazole was started. The patient’s condition was rapidly improved, and one week later he was discharged from the ICU. Conclusions: Pleural empyema can lead to sepsis and septic shock and the correct diagnostic and therapeutic approach is crucial for patient survival.

empyema, thoracic trauma, sepsis, septic shock

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