Chronic Empyema Necessitans Perpetuated by ESBL.

A man with prior tuberculosis developed recurrent empyema necessitans, complicated by extended-spectrum beta-lactamase. Despite prolonged antimicrobials, serial imaging revealed a persistent pleurocutaneous fistula and pleural thickening. This case highlights that not all empyema necessitans is tuberculous, and delayed surgical intervention may necessitate morbid procedures such as pleural window.