Uncommon Etiology of Pleural Empyema: Enterococcus faecalis in an Immunocompetent Host.

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.