Mixed and Infection Causing Empyema Necessitatis and Multiple Skin Abscesses in an Immunocompetent Patient

A 45-year-old- man presented with left chest wall pain, swelling and cough. Over a 2-month period he developed abscesses in the right foot, right anterior thigh, left buttock and left chest. Incision and drainage of the soft tissue abscesses and video-assisted thoracoscopic surgery to drain the loculated empyema contiguous with the chest wall abscess were performed as surgical management. Gram stain showed beaded Gram-positive rods and the culture initially grew Pathological evaluation of the pleura showed sulfur granules and organisms consistent with on Gomori methenamine silver stain; was recovered in culture with extended incubation. The patient was treated for 3 weeks with ceftriaxone and oral metronidazole, followed by oral amoxicillin. Culture of with other findings consistent with actinomycosis warrants 6-12 months of antibiotic therapy.