BMJ Case Reports 2013; doi:10.1136/bcr-2013-008700

Pleural infection: a case where clinical improvement was misleading

  1. Justin Gould
  1. Department of General Medicine, Maidstone & Tunbridge Wells NHS Trust, Tunbridge Wells, Kent, UK
  1. Correspondence to Dr Justin Gould; justin.gould{at}


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.

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