# Complex Interplay of Empyema and Chylothorax: A Case Report With Nutritional and Clinical Implication

## TL;DR

A rare case of a patient with both empyema and chylothorax highlights the need for early diagnosis and multidisciplinary care to improve outcomes.

## Contribution

This case report highlights the rare and complex interplay of empyema and chylothorax in an immunocompromised patient.

## Key findings

- Concurrent empyema and chylothorax occurred in a 78-year-old male with small-cell lung cancer.
- Management included antibiotics, drainage, octreotide, and parenteral nutrition, but the patient died from ventilator-associated pneumonia.
- The case emphasizes the importance of early diagnosis and multidisciplinary care for combined pleural complications.

## Abstract

Empyema and chylothorax are distinct but serious pleural space complications, with the simultaneous occurrence being exceedingly rare and clinically challenging. We present the case of a 78-year-old immunocompromised male with small-cell lung cancer who developed concurrent empyema and chylothorax. The patient presented with respiratory distress and signs of sepsis, and imaging revealed pleural effusion with lung collapse. Thoracostomy yielded a large volume of milky, purulent chylous fluid positive for Streptococcus sp., confirming infected chylothorax (empyema). Management included broad-spectrum tailored antibiotics, chest tube drainage, octreotide administration, and a parenteral nutrition regimen to address nutritional losses from chyle leakage. Despite initial clinical improvement, the patient succumbed to ventilator-associated pneumonia after 20 days of hospitalization. This rare case underscores the critical importance of early diagnosis and a multidisciplinary approach, including tailored nutritional therapy, for optimizing outcomes in patients with combined empyema and chylothorax.