Protracted tuberculous empyema necessitans following intercostal drainage tube insertion

Empyema necessitans (EN) is a rare long-term sequela of poorly or untreated empyema thoracis, characterized by the dissection pus through soft tissues and skin chest wall, ultimately forming fistula between pleural cavity. We herein present male patient in his late 30s, known case tuberculosis (TB) on anti-tubercular therapy (ATT) under directly observed treatment short-course (DOTS), who recently came with complaints backache for 3 days. Chest X-ray showed massive effusion, view which an intercostal drainage tube (ICD) was inserted 1.5 L fluid drained. An ultrasound (USG) back done revealed subcutaneous collection communication to space, resolved after drainage. As there persistent space right-sided plane effusion i.e., EN, he advised undergo thoracotomy decortication resection underwent successfully. This presented its rarity atypical presentation.