title: Spontaneous bilateral bacterial empyema in a patient with nephrotic syndrome.
abstract: Spontaneous bacterial empyema (SBEM), a rare infectious complication among liver cirrhosis patients, is characterized by infection in the presence of pleural effusion without evidence of pre-existing pneumonia. The prevalence of SBEM in cirrhotic patients with hydrothorax is about 13%. However, it has previously not been reported in medical literature in patients with nephrotic syndrome. The most common microorganism identified is Escherichia coli, followed by Streptococcus species, Enterococcus species, Klebsiella pneumoniae, and Pseudomonas stutzeri. We present a patient with a history of nephrotic syndrome caused by membranous nephropathy, who received steroids and cyclophosphamide. He developed bilateral SBEM due to Aeromonas hydrophila and E. coli, which were isolated from the left- and right-side pleural fluid, respectively. The detailed clinical course, treatment, and outcome are described.
authors.affiliation: Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University Medical College, Taipei, Taiwan.
authors.forename: Wan-Chin
authors.initials: WC
authors.lastname: Chen
authors.forename: Jenq-Wen
authors.initials: JW
authors.lastname: Huang
authors.forename: Kuan-Yu
authors.initials: KY
authors.lastname: Chen
authors.forename: Po-Ren
authors.initials: PR
authors.lastname: Hsueh
authors.forename: Pan-Chyr
authors.initials: PC
authors.lastname: Yang
mesh_terms: D000328:Adult; D000667:Ampicillin / Q000627:therapeutic use; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D002439:Cefotaxime / Q000627:therapeutic use; D004653:Empyema / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology*; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects; D008171:Lung Diseases / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology*; D008297:Male; D009404:Nephrotic Syndrome / Q000150:complications*; D013407:Sulbactam / Q000627:therapeutic use
chemical_list: D000900:Anti-Bacterial Agents; D007166:Immunosuppressive Agents; D000667:Ampicillin; D002439:Cefotaxime; D013407:Sulbactam