Empyema in a Woman with Cystic Fibrosis: A Cautionary Tale

Anne Coates,Oren Schaefer,Brian P O'Sullivan,Karl Uy

doi:10.1155/2013/159508

Abstract

Cystic fibrosis (CF) is a disease which predisposes individuals to recurrent infective exacerbations of suppurative lung disease; however, empyema is a rare complication in these patients. Empyemas secondary to Staphylococcus aureus and Burkholderia cepacia have been described in patients with CF. We report the case of pleural empyema with mixed S. aureus and Pseudomonas aeruginosa infection in a 34-year-old woman with CF, which was managed with ultrasound-guided pigtail catheter insertion, fibrinolysis, and antibiotic therapy. Physicians should be aware of this unusual complication in CF patients, especially those receiving an immunosuppressive therapy.

Highlights

Cystic fibrosis (CF) is an autosomal recessively inherited genetic disorder caused by mutations of the CF transmembrane conductance regulator (CFTR) gene
We present a case of pleural empyema in an adult with CF who had mild lung disease at baseline and was not a transplant recipient
Empyema is by definition pus in the pleural space

Summary

Introduction

Cystic fibrosis (CF) is an autosomal recessively inherited genetic disorder caused by mutations of the CF transmembrane conductance regulator (CFTR) gene. Parapneumonic effusion is an accumulation of exudative pleural fluid associated with an ipsilateral pulmonary infection. This is a relatively common consequence of pneumonia in those without CF, occurring in 20–40% of nonCF patients admitted to the hospital with pneumonia [3]. CF patients rarely develop parapneumonic effusions or empyemas, despite their chronic airway infection. We present a case of pleural empyema in an adult with CF who had mild lung disease at baseline and was not a transplant recipient. She was, receiving low-dose immunosuppression for treatment of allergic bronchopulmonary aspergillosis (ABPA). As anti-inflammatory therapy is further adopted as part of routine CF care, it is likely that this complication will become more common

Case Report

Findings

Discussion