Introduction:

empyema is defined as a purulent collection in the pleural cavity, its bilateral and symmetrical manifestation is rare, which implies a currently non-existing standardized assessment criterion. Its broad differential diagnoses should consider infectious as well as neoplastic disorders.

Clinical case:

a 60-year-old male with a previous history of tobacco use, alcohol abuse and exposure to biomass fuels. Current complaint of a 2-month history of sharp pain located on right hemithorax, fever, weakness, loss of appetite, weight loss of 10 kg, night sweats and unproductive cough; upon physical examination perceived with cachectic appearance, diminished strength of lower limbs and altered gait. Magnetic resonance imaging showed two T1 hypointense and T2 hyperintense oval lesions extending to the vertebral body of T11, along with manifestations of spondylodiscitis resulting in medullary contact. Analysis of pleural fluid reports a foul-smelling, purulent aspect, increased polymorphonuclear cell count, lactic dehydrogenase 20,376 U/L; culture negative, negative neoplastic histological and cytological typing as well as Ziehl-Neelsen staining negative.

Conclusions:

this case is therefore approached due to respiratory symptoms consistent with a bilateral manifestation empyema associated to a vertebral lesion, an infrequent association, aided by imaging resources to reach a final diagnosis of bone tuberculosis.