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Spontaneous Bacterial Empyema — SCE Infectious Diseases MCQ

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ModerateHepatitisSpontaneous Bacterial EmpyemaSCE Infectious Diseases

A 50-year-old man with cirrhosis develops a large right-sided hydrothorax (hepatic hydrothorax). Diagnostic thoracentesis shows: neutrophils 350 cells/µL, protein 8 g/L. He has no pneumonia. What does this represent?

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Correct answer: A — Spontaneous bacterial empyema (SBEM) — analogous to SBP but in the pleural space; treat with IV antibiotics (Ceftriaxone) as for SBP

Hepatic hydrothorax with neutrophils ≥250 cells/µL in the absence of pneumonia is spontaneous bacterial empyema (SBEM) — the pleural equivalent of SBP. Like SBP, it occurs through haematogenous bacterial seeding of the low-protein pleural fluid. Treatment is IV antibiotics (same regimen as SBP — Ceftriaxone or Cefotaxime). Unlike parapneumonic empyema, SBEM generally does NOT require chest drain insertion (which can cause complications in cirrhotic patients). IV albumin should also be considered.

Reference: EASL 2024 – Decompensated cirrhosis; BSG 2021 – Ascites complications