Empyema Necessitans: A Rare Complication of Chest Drains.

Empyema is defined as an accumulation of frank pus within the pleural cavity. Empyema necessitans is a rare complication of the pleural space infection when the existing empyema extends into adjacent structures beyond the pleural space, usually into the soft tissue of the chest wall. If severe, it can externalize to the skin. Historically, one of the most common causes of this condition was uncontrolled tuberculous infections. Our study describes a case where empyema necessitans could be classed as iatrogenic. This patient was initially admitted for empyema secondary to community-acquired pneumonia, which was successfully treated with a course of antibiotics and insertion of a chest drain. She was discharged but had to be re-admitted after one month, this time with a chest wall swelling at the point of recent chest drain insertion, which began to ooze purulent discharge. Imaging confirmed the diagnosis of empyema necessitans, which was then treated with a combination of surgical and antimicrobial therapy. Empyema necessitans are now seldom encountered, owing mainly to effective antibiotics and anti-tuberculous treatment. It is perhaps even more rarely seen as a complication of chest drain insertion. However, the report emphasizes the need to consider empyema necessitates in the list of differentials when assessing a patient with chest wall swelling, particularly where they have recently undergone pleural intervention.

Labyrinthitis: A Rare Consequence of COVID-19 Infection.

Since the declaration of coronavirus disease 2019 (COVID-19) as a pandemic, it remains a widespread infection with a major impact on global resources and health infrastructure. The hallmark of COVID-19 continues to be the well-documented effects it has on the respiratory system. With the passage of time, the involvement of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus in other systems has become more apparent, with the increased incidence of thromboembolic events, cardiac involvement as well as gastrointestinal and neurological symptoms secondary to the infection. Our case report demonstrates a presentation of vertigo, hearing loss, tinnitus, and aural fullness. Our patient was diagnosed as positive for COVID-19 by reverse transcription-polymerase chain reaction (RT-PCR) nine days prior to developing these symptoms. Her COVID-19 infection was otherwise relatively mild, for which she did not seek any medical intervention. A careful assessment ruled out cerebrovascular causes and led us to the diagnosis of SARS-CoV-2-induced labyrinthitis. Our patient was successfully treated as an outpatient without unnecessary investigations and responded well to standard therapy for viral labyrinthitis as per National Health Service (NHS) guidelines. She eventually reported having made a full recovery within three weeks of the initial encounter. Audio-vestibular consequences of COVID-19 are less reported compared to other symptoms of neurological involvement, such as gustatory or olfactory dysfunction, which have become key indicators aiding in the diagnosis of the infection. Among these disorders, the commonly reported presentation is that of vestibular neuronitis. Our case report demonstrates that labyrinthitis is also among the neurological manifestations to be considered as a result of COVID-19, which can be safely managed in the community with the same strategies as those employed for other viral triggers. It also reveals the need for further research into the effects that COVID-19 may have on the audio-vestibular system.

Brucellosis: An Elusive Backyard Agent.

Brucellosis is a form of zoonotic infection caused by various Brucella organisms. It most commonly presents as a case of pyrexia of unknown origin, alongside symptoms such as night sweats, malaise, arthralgias, and myalgias. This report describes the case of a man who presented with pyrexia of unknown origin for one month; he was diagnosed to be a case of brucellosis after enteric fever was ruled out. Investigations were ordered as it was a differential diagnosis with high clinical suspicion due to the presenting complaint and potential exposure of tainted consumable products. The systemic disease was determined to be brucellosis following blood results demonstrating positive antibody titers, and the suspicion of exposure due to widespread inadequacies in sterilization of food products.