Refractory Nontyphoidal Salmonella Empyema Necessitans in a Man Living With HIV: A Case Report and Review of the Literature

Empyema necessitans is a rare complication of untreated/undertreated empyema characterized by the invasion and progression of empyema beyond the pleura into the chest wall. With the availability of antibiotics, empyema necessitans is now rarely seen in clinical practice. Effective treatment of empyema necessitans entails aggressive source control with surgical decortication in conjunction with prolonged culture-directed antibiotics. The most common etiologies include Mycobacterium tuberculosis , Actinomyces , Staphylococcus aureus , and Streptococcus specie s. Here, we report a case of refractory nontyphoidal Salmonella empyema necessitans in a patient who is virologically suppressed on HIV treatment and highlight the challenges in management when surgical decortication could not be performed.