Streptococcus constellatus Empyema: A Case Highlighting the Need for Timely Surgical Intervention

This case report explores the intricate challenges of diagnosing and managing empyema caused by Streptococcus constellatus, particularly in patients with predisposing factors such as alcohol abuse and underlying respiratory conditions. We present a 34-year-old male patient with a medical history of hypertension, peripheral neuropathy, and alcohol abuse who developed empyema. Despite an initial presentation at another facility with symptoms mimicking a myocardial infarction and unremarkable chest X-ray results, his condition worsened, leading to a subsequent emergency department visit. The patient's persistent pleuritic chest pain and fever were initially managed with ibuprofen and steroids, which proved ineffective. Upon re-evaluation, he exhibited hemodynamic instability, and imaging revealed a moderate pleural effusion. An urgent chest tube placement drained over 1600 ml of purulent fluid, with cultures confirming S. constellatus. The patient was treated with broad-spectrum antibiotics and intrapleural administration of tissue plasminogen activator and dornase alfa; however, unresolved effusion necessitated video-assisted thoracoscopic surgery (VATS). This intervention successfully eradicated the infection. The case underscores the importance of considering less common pathogens like S. constellatus in atypical empyema cases and emphasizes the critical role of VATS in resolving complex pleural infections. Early recognition, comprehensive management strategies, and a high index of clinical suspicion are vital to reducing morbidity and mortality associated with such infections.