title: Pleural infection: a case where clinical improvement was misleading.
abstract: A 28-year-old Gurkha soldier presented with signs of severe chest sepsis and respiratory distress. High-flow oxygen, broad-spectrum intravenous antibiotics and intravenous fluids were started immediately. Bedside thoracic ultrasound demonstrated a moderate right pleural effusion suggestive of an empyema. A pleural aspirate was borderline for pleural infection, therefore, a chest drain was inserted and the patient was transferred to high dependency. Within 48 h the patient clinically improved. Three weeks later, a persistently raised C reactive protein and indeterminate right lower lobe radiographic changes was observed. Video-assisted thorascopic surgery was subsequently performed. Although technically difficult, a large amount of pus was drained from the pleural cavity. The patient was discharged, returning to normal army duties 8 weeks later. Follow-up chest radiographs showed complete resolution of the empyema and no evidence of scarring. The CRP normalised to <1.
authors.affiliation: Department of General Medicine, Maidstone & Tunbridge Wells NHS Trust, Tunbridge Wells, Kent, UK. justin.gould@doctors.org.uk
authors.forename: Justin
authors.initials: J
authors.lastname: Gould
mesh_terms: D000328:Adult; D001999:Bronchoscopy; D002097:C-Reactive Protein / Q000032:analysis; D015505:Chest Tubes; D003937:Diagnosis, Differential; D003952:Diagnostic Imaging; D016724:Empyema, Pleural / Q000175:diagnosis* / Q000601:surgery*; D006801:Humans; D008297:Male; D020775:Thoracic Surgery, Video-Assisted
chemical_list: D002097:C-Reactive Protein