A 68 year old woman, treated with prednisone and infliximab for rheumatoid arthritis, presented with two periods of thoracic empyema in two subsequent winters. H influenzae was cultured in the first infectious period and S pneumoniae during the second. Direct stains, polymerase chain reaction, and cultures for mycobacteria remained negative in both periods. She was treated with intravenous antibiotics and a closed drainage system. Infliximab was discontinued after the first infectious …