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Spontaneous bacterial empyema: an elusive diagnosis in a patient with cirrhosis
  1. Sarthak Soin,
  2. Nehan Sher,
  3. Nasir Saleem
  1. Internal Medicine, Presence Saint Joseph Hospital Chicago, Chicago, Illinois, USA
  1. Correspondence to Dr Sarthak Soin, sarthaksoin{at}


Hepatic hydrothorax refers to the presence of a pleural effusion (usually >500 mL) in a patient with cirrhosis in whom other causes of pleural effusion, such as cardiopulmonary causes, pleural disease or malignancy have been excluded. It is seen in 5%–10% of patients with end-stage liver disease. A subset of these patients can develop infection of the hepatic hydrothorax, called spontaneous bacterial empyema. They may present with fever, chills and dyspnoea. We present the case of an 83-year-old man with a history of cirrhosis who developed a large right-sided pleural effusion, confirmed to be empyema by pleural fluid analysis. We aim to highlight the occurrence of spontaneous bacterial empyema. While less common that spontaneous bacterial peritonitis as a complication of cirrhosis, it is equally serious with potential for adverse outcomes.

  • cirrhosis
  • alcoholic liver disease
  • adult intensive care
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  • Contributors SS, NS and NaS contributed equally to the study concept and design, analysis and interpretation of data and writing and critical revision of the manuscript. SS is the article guarantor.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests Not required.

  • Patient consent Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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