Abstract
Empyema, a type of pleural effusion characterized by pus accumulation in the pleural space, is most often caused by bacterial infections, typically as a complication of pneumonia. This case report presents a 70-year-old man with chronic obstructive pulmonary disease (COPD), rheumatoid arthritis, and chronic bilateral hydropneumothoraces, who developed pyopneumothorax due to dual infections with Haemophilus influenzae and Aspergillus terreus. The patient presented with worsening dyspnea, hypoxemia, and respiratory acidosis, requiring hospitalization and chest tube thoracostomy. Cultures from purulent pleural fluid identified H. influenzae and A. terreus, necessitating a multidisciplinary approach involving antimicrobials, infectious disease consultation, and pulmonary care. Despite initial improvement, the patient experienced recurrent pyopneumothorax, highlighting challenges in managing complex polymicrobial pleuropulmonary infections. This case underscores the importance of considering rare pathogens in empyema, particularly in patients with chronic pleuropulmonary conditions, and emphasizes the need for close follow-up and tailored therapeutic strategies to optimize outcomes.