Streptococcus gordonii Empyema: A Rare Presentation of Streptococcus gordonii Infection

Empyema is often caused by Streptococcus pneumoniae, Staphylococcus aureus, and a variety of gram-negative organisms as well as anaerobes. Streptococcus gordonii (S. gordonii) is among some of the initial colonizers of the periodontal environment that is recognized to cause bacterial endocarditis. However, there are only a few case reports of S. gordonii causing empyema in the literature. We report the case of a 75-year-old male who presented with coughing up blood-tinged sputum. Physical examination revealed decreased breath sounds in the right lung base. Chest X-ray demonstrated a lower, right-sided, loculated pleural effusion. He underwent ultrasound-guided chest tube placement. The pleural fluid culture grew S. gordonii. He was started on ampicillin/ sulbactam. The follow-up computed tomography (CT) scan showed no significant improvement. Given his inability to improve with antibiotics and chest tube drainage, he was referred to an advanced care center for decortication of lung tissue.