cilastatin--imipenem-drug-combination and Empyema--Pleural

Mycobacterium fortuitum is a rapidly growing nontuberculous mycobacterium. This microorganism is an uncommon etiological agent of lung lesions; among lung lesions caused by M. fortuitum, thoracic empyema is particularly rare. A 61-year-old man who had been treated for chronic hypercapnic respiratory failure with noninvasive ventilation was admitted because of breathing difficulty and was found to have M. fortuitum thoracic empyema. He improved after the administration of amikacin, imipenem/cilastatin, and clarithromycin following sulfamethoxazole/trimethoprim and clarithromycin. This is the first report of M. fortuitum thoracic empyema in a patient without human immunodeficiency virus infection. The thoracic empyema may have developed via a pulmonary fistula in this case. This case highlights the fact that we must be aware of the possibility of M. fortuitum thoracic empyema, especially in patients with M. fortuitum lung infection and treatment with noninvasive ventilation. Multidrug therapy may be effective and important to the resolution of M. fortuitum thoracic empyema.

Topics: Amikacin; Anti-Bacterial Agents; Chronic Disease; Cilastatin; Cilastatin, Imipenem Drug Combination; Clarithromycin; Drug Combinations; Drug Therapy, Combination; Empyema, Pleural; Humans; Hypercapnia; Imipenem; Male; Middle Aged; Mycobacterium fortuitum; Noninvasive Ventilation; Sulfamethoxazole

Granulomatosis with polyangiitis (GPA) (Wegener's) is a multiorgan system disease of unknown aetiology characterised by granulomatous inflammation, tissue necrosis and vasculitis. The characteristic lung parenchymal lesions of GPA are firm spherical nodules that may cavitate. Pneumothorax (PX) can develop as a quiet rare complication of cavitary nodules. Our case admitted to our clinic with the diagnosis of GPA showing cavitary pulmonary mass. While taking immunosuppressive treatment, spontaneous PX on left lung was developed. A closed chest tube was inserted to the left lung for expansion of PX. Even after 30 days, the left lung did not re-expand and wedge resection with thoracotomy was conducted and the closed chest tube was still in the left lung. On the seventh day, empyema emerged as a complication and, with appropriate treatment, the patient became well. In GPA patients taking immunosuppressive medication, PX is a serious complication and requires aggressive therapy with broad-spectrum antibiotics.

Topics: Adult; Anti-Bacterial Agents; Anti-Inflammatory Agents; Cilastatin; Cilastatin, Imipenem Drug Combination; Cyclophosphamide; Drug Combinations; Empyema, Pleural; Granulomatosis with Polyangiitis; Humans; Imipenem; Immunosuppressive Agents; Lung Diseases; Male; Pneumothorax; Prednisone; Pseudomonas aeruginosa