Complicated parapneumonic effusion in a patient with kidney failure: A case report

Abstract

Pleural effusion (PE) refers to excess fluid in the pleural space and depending on its origin, is classified into: transudates and exudates. Chronic kidney disease (CKD) is a major public health problem; respiratory complications are detected in up to 70% of cases, with PE being one of the most frequent. The case of a 66-year-old male patient with CKD in the terminal phase, on hemodialysis, who was admitted to the emergency service of the Mario Catarino Rivas National Hospital with a history of dyspnea, orthopnea and paroxysmal nocturnal dyspnea, preceded by chronic dry cough, is presented. The initial chest x-ray confirmed bilateral PE with a right predominance and the diagnostic thoracentesis revealed pleural fluid (PF) proteins: 3.5 g/dl, which when related to serum proteins (3.5 g/dl) the result was greater than 0.5, indicating exudate, according to Light's criteria. The initial secretion culture was negative, however, due to unfavorable evolution, a new PF culture was performed, which was positive for Enterococcus faecalis sensitive to vancomycin, so an infection associated with health services was diagnosed and corresponding antibiotic coverage was initiated. However, due to the persistence of PE, a contrast-enhanced computed tomography (CT) of the chest was ordered, which concluded in complicated parapneumonic pleural effusion (CPPE) with predominantly right-sided empyema. The chest tube was collapsed, so it was changed and subsequently drained approximately 600 ml, favoring the patient's clinical evolution.