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SBEM Diagnosis — SCE Infectious Diseases MCQ

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ModerateHealthcare-Associated InfectionsSBEM DiagnosisSCE Infectious Diseases

A 60-year-old man with liver cirrhosis develops fever and left-sided chest pain. He has a known left-sided pleural effusion (hepatic hydrothorax). Diagnostic thoracentesis shows: neutrophils 320/µL, protein 9 g/L, glucose 3.5 mmol/L. He has no pneumonia on CXR. What is the diagnosis?

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Correct answer: D — Spontaneous bacterial empyema (SBEM) — ascitic neutrophils ≥250/µL in a hepatic hydrothorax without pneumonia; treat as for SBP with IV Ceftriaxone

Hepatic hydrothorax with pleural fluid neutrophils ≥250/µL without pneumonia defines SBEM — the pleural analogue of SBP. It results from transdiaphragmatic migration of infected ascitic fluid or haematogenous bacterial seeding of the low-protein pleural fluid. Treatment follows SBP protocol: IV Ceftriaxone (or Cefotaxime). Unlike parapneumonic empyema, SBEM generally does NOT require chest drain insertion (risk of protein loss, electrolyte derangement, and hepatic decompensation in cirrhotic patients). IV albumin may be administered as for SBP.

Reference: EASL 2024 – Cirrhosis complications; BSG 2021 – Ascites