 |
Vol.49 No.6 contents | Japanese/English |
 | Full Text of PDF (836K) Article in Japanese |
- Case Report -
A Case of Pulmonary Adenocarcinoma Complicated with Methicillin-resistant Staphylococcus Aureus (MRSA) Empyema During Adjuvant Chemotherapy Successfully Treated with Thoracoscopic Debridement and Intrathoracic Lavage
Kazuhiko Kataoka1, Toshiya Fujiwara1, Motoki Matsuura1, Noritomo Seno11Department of Thoracic Surgery, Hiroshima City Hospital, Japan
Background. There are few reports of empyema occurring during postoperative adjuvant chemotherapy of the lung cancer. Case. A 74-year-old man was referred to our hospital because of an abnormal shadow on the chest CT. Right upper lobectomy with ND2a lymph node dissection was performed and the pathological diagnosis was primary adenocarcinoma (pT4N0M0, p0d0E0pm1, stage IIIB). Postoperative adjuvant chemotherapy with carboplatin and weekly paclitaxel was performed. On the 14th day of the 4th course, he developed high fever and was admitted. Chest X-ray and CT showed a large amount of pleural effusion in the right side. Chest tube drainage was performed, and the culture of pleural effusion revealed empyema caused by methicillin-resistant Staphylococcus aureus. Despite the continuous irrigation and the administration of vancomycin, CT on the 7th day of the admission showed pleural effusion in the posterior and supradiaphragmatic spaces. Thoracoscopic debridement of the empyema space under minithoracotomy was performed and 3 double-lumen drainage tubes were inserted on the 10th day after admission. We continued intrathoracic lavage and changed medication from vancomycin to linezolid. The drainage tubes were sequentially removed when the culture of the effusion turned negative. The patient was discharged on the 47th day after the operation. He has shown neither the original disease nor recurrence of the empyema for 22 months. Conclusion. There is a possibility of developing empyema during postoperative adjuvant chemotherapy of the lung cancer due to immunosuppression. When the empyema is not improved by conservative therapy, early thoracoscopic debridement must be performed.
key words: Empyema, Postoperative adjuvant chemotherapy, Methicillin-resistant Staphylococcus aureus, Thoracoscopic debridement
Received: January 13, 2009
Accepted: May 14, 2009
JJLC 49 (6): 863-867, 2009
