Case report reveals enterococcus faecalis as a rare cause of pleural empyema in an immunocompetent host, highlighting the need for early recognition and effective drainage.
Pleural empyema is usually a complication of pneumonia caused by common bacteria such as Streptococcus pneumoniae or Staphylococcus aureus . Empyema due to Enterococcus faecalis is exceedingly rare, especially in the immunocompetent individuals. We report the case of a 75-year-old male with no significant immunosuppression who presented with progressive dyspnea and pleuritic chest pain. Imaging revealed a loculated right-sided pleural effusion. Thoracentesis yielded purulent fluid and culture grew E . faecalis . The patient was treated successfully with chest tube drainage, broad-spectrum antibiotics, and intrapleural fibrinolytic therapy (streptokinase) without requiring surgical decortication. He made a full recovery with complete lung re-expansion. This rare case highlights that E . faecalis can cause empyema even in immunocompetent patients. Early recognition, image-guided drainage, appropriate antibiotics, and adjunctive intrapleural fibrinolysis can lead to favorable outcomes, avoiding invasive surgery.
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Gabhale et al. (2025) studied this question.
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