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

## TL;DR

A rare case of empyema necessitans caused by Salmonella in an HIV patient is reported, highlighting management challenges when surgery is not possible.

## Contribution

This case report presents a rare instance of nontyphoidal Salmonella causing empyema necessitans in an HIV patient.

## Key findings

- Empyema necessitans caused by nontyphoidal Salmonella is rare and challenging to manage without surgical decortication.
- The patient was virologically suppressed on HIV treatment but still developed this severe infection.
- Management relied on prolonged culture-directed antibiotics due to inability to perform surgery.

## Abstract

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 species. 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.