Journal of Liver: Doença e Transplante

Spontaneous Bacterial Empyema Caused by Haemophilus Influenzae in a Patient with Decompensated Alcoholic Liver Cirrhosis

Ushigusa T, Sasaki R, Akazawa Y, Shibata H, Miuma S, Miyaaki H, Taura N, Nakao K

Introduction: Spontaneous bacterial empyema (SBEM) is an infection of a preexisting hydrothorax in patients with cirrhosis. Haemophilus influenzae (H. influenzae) is a Gram-negative bacteria that is commonly involved in upper and lower respiratory infections. Herein, we report our experience with SBEM in a patient with decompensated alcoholic liver cirrhosis caused by H. influenzae.

Case presentation: A 63-year-old man with alcoholic decompensated liver cirrhosis, Child-Pugh class C, and a Model for End-Stage Liver Disease score of 21, was admitted to our hospital. On admission day (day 1), the patient had jaundice with icteric conjunctiva, decreased lung sounds in entire right side of the chest. On the next day (day 2), the patient had fever of 39.2℃. A Gram stain of the pleural effusion revealed Gram-negative rods with remarkable leukocytosis. The blood and pleural effusion cultures were both positive for beta-lactamase-negative ampicillin-resistant H. influenzae. In spite of intensive care for septic shock, his comatose status and liver failure had not improved, and on day 21, the patient died of multiorgan failure.

Conclusion: Although H. influenzae is thought to be an indigenous microorganism in the respiratory tract, to our knowledge, there are no case reports of H. influenzae as a causative bacterium of SBEM. Our case suggests that it is essential to investigate the pathogenesis of hepatic hydrothorax in patients with cirrhosis as well as to offer systemic management and care for bacterial infections.