Thoracoscopic examination of empyema in a patient with sparganosis mansoni.

A 27-year-old man was admitted to our hospital with right pleural effusion. He had suffered from right chest and back pain and a high fever for one week prior to the admission. He had been treated with clarithromycin without improvement. Since thoracoscopy under local anesthesia revealed purulent effusion, synechiae and fibrous septa in the thoracic cavity, synechiotomy was performed and we started antibiotic treatment with the diagnosis of acute bacterial empyema. At the same time, we also suspected parasitic infection because of massive eosinophilic infiltration in pleural effusion and his dietary history of eating raw frogs. During the course of the disease, he had an infiltration in the right lower lobe and pneumothorax. Finally, we diagnosed him with sparganosis mansoni because his serum as well as pleural effusion was positive for the binding to sparganosis mansoni plerocercoid antigen, without any positive findings in bacteriology. His pleural effusion and lung infiltration were resolved after the administration of a high-dose praziquantel. We report this rare parasitic empyema with findings by thoracoscopic examination.

Co-occurrence of diaphragmatic and serratus anterior muscle hydatidosis: an unusual localization.

BACKGROUND: With hydatid cyst, the skeletal muscles and diaphragm are rarely affected, and hepatic and pulmonary hydatid cysts are far more common. We report a case with an unusual localization of diaphragmatic and serratus muscle anterior hydatidosis that occurred simultaneously. CASE REPORT: A 37-year-old developmentally disabled woman presented to the Emergency Department (ED) of Harran University with tachycardia, tachypnea, and dyspnea. On pulmonary auscultation, breath sounds were decreased on the right side. A chest X-ray study revealed a radiopaque right hemithorax with a mediastinal shift and tracheal displacement. Thoracic computed tomography scan revealed a hydatid cyst in the serratus muscle anterior and cystic vesicles in the pleural cavity. The patient underwent chest drainage. During drainage, daughter vesicles within the pus were detected macroscopically. An elective thoracotomy was performed after hemodynamic stabilization of the patient. Postoperative chest X-ray study demonstrated that the lungs had re-expanded. The patient had no postoperative complications and was discharged with relief of all symptoms. CONCLUSION: Hydatid cyst should be considered, especially in endemic regions, in the differential diagnosis in the presence of a rare localization or unexpected clinical presentation. Surgical intervention is the appropriate approach for the treatment of hydatid cyst when there is concomitant intrathoracic involvement.

Disseminated microfilaremia associated with lung cyst and empyema: an autopsy report.

Clinical manifestations of extralymphatic disease caused by filariasis are varied and range from symptoms due to tropical pulmonary eosinophilia to hematuria, proteinuria, splenomegaly, and rarely arthritis. Disseminated microfilaremia in association with loculated lung cyst and empyema is of rare occurrence and to the best of our knowledge has not been documented in the literature so far. We report here a case of disseminated microfilaremia due to Wuchereria bancrofti infection accompanied by a lung cyst and empyema in a 21-year-old Indian man.

Unsuspected Toxoplasma gondii empyema in a bone marrow transplant recipient.

Toxoplasma gondii is an opportunistic parasite that can cause severe disease in immunosuppressed individuals. We report a case of unsuspected T. gondii empyema in a bone marrow transplant recipient that was diagnosed by the visualization of numerous intracellular and extracellular tachyzoites in Giemsa- and Gram-stained smears. The patient was treated with pyrimethamine, sulfadiazine, clindamycin, and atovaquone, and she survived 110 days after diagnosis, despite having a large parasite burden.

Empyema with Trichomonas species.

A 35-year-old alcoholic male patient developed an empyema secondary to presumed aspiration pneumonia. Trichomonads were demonstrated on wet mounts and Wright-Giemsa-stained, air-dried smears of pleural fluid. Treatment with metronidazole, other antimicrobial drugs, and drainage was successful in curing the empyema.