Empyema in Rheumatoid Pleuropulmonary Disease

Abstract

Empyema is a rather common but generally unappreciated complication of rheumatoid pleuropulmonary disease. Of 10 patients with rheumatoid pleural effusions observed during a 5-year period, 5 developed empyema. These patients constituted 16% of all the adult cases of empyema seen in one institution. In contrast, no individual with neoplastic effusion or hydrothorax seen during this period had empyema. Causative factors that may act singly or in combination in the development of empyema include steroid therapy, decreased resistance to infection, chronic bronchopulmonary infections, the preexistence of rheumatoid pleural effusion, altered biochemical characteristics of the fluid, and, in particular, the formation of bronchopleural fistulas through necrotic subpleural rheumatoid nodules.