# Empyema associated with Actinomyces georgiae successfully treated with multimodal therapy including surgical intervention: A first case report

## TL;DR

This case report describes the first instance of empyema caused by Actinomyces georgiae, successfully treated with surgery and long-term antibiotics.

## Contribution

The first documented case of empyema associated with Actinomyces georgiae and its treatment approach.

## Key findings

- Initial antibiotic and drainage therapy failed to resolve A. georgiae empyema.
- Surgical intervention (VATS) and 11 months of antibiotics were required for recovery.
- Actinomyces should be considered in empyema cases, requiring multimodal treatment.

## Abstract

A 77-year-old man presented with right-sided chest pain and dyspnea. Computed tomography revealed a loculated pleural effusion, and thoracentesis yielded purulent fluid. Actinomyces georgiae was identified using pleural fluid culture. Despite treatment with ampicillin-sulbactam and thoracic drainage, the patient's condition worsened, requiring video-assisted thoracoscopic surgery. The patient recovered completely after completing an 11-month course of antibiotics. This is the first reported case of empyema associated with A. georgiae. Actinomyces should be considered as a potential cause of empyema, and a comprehensive approach, including surgical intervention, is necessary for optimal management.

•First report of empyema associated with Actinomyces georgiae.•Failed initial antibiotics/drainage for A. georgiae empyema.•Required VATS decortication and prolonged (11-month) antibiotic therapy.•Actinomyces empyema often requires surgical intervention for resolution.•Consider Actinomyces in empyema; long-term antibiotics are essential.

First report of empyema associated with Actinomyces georgiae.

Failed initial antibiotics/drainage for A. georgiae empyema.

Required VATS decortication and prolonged (11-month) antibiotic therapy.

Actinomyces empyema often requires surgical intervention for resolution.

Consider Actinomyces in empyema; long-term antibiotics are essential.