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

Sanjay Gabhale1, Parna Chakraborty2, Brahmansh Singh3

  • 1Department of Respiratory Medicine, Dr. D. Y. Patil Medical College, Hospital and Research Centre, Pune, Maharashtra, India.

Annals of African Medicine
|November 19, 2025
PubMed

Insights

Enterococcus faecalis empyema is rare, even in immunocompetent patients. This case shows successful treatment with drainage, antibiotics, and fibrinolysis, avoiding surgery.

Area of Science:

  • Medicine
  • Infectious Diseases
  • Pulmonology

Background:

  • Pleural empyema is typically a complication of pneumonia caused by common bacteria.
  • Empyema due to Enterococcus faecalis is exceptionally rare, particularly in immunocompetent individuals.

Purpose of the Study:

  • To report a rare case of Enterococcus faecalis empyema in an immunocompetent patient.
  • To highlight successful non-surgical management strategies for this rare condition.

Main Methods:

  • Case report of a 75-year-old male with no significant immunosuppression.
  • Diagnosis confirmed by imaging and thoracentesis with positive E. faecalis culture.
  • Treatment involved chest tube drainage, broad-spectrum antibiotics, and intrapleural streptokinase.

Main Results:

  • The patient presented with dyspnea and pleuritic chest pain, with imaging revealing a loculated pleural effusion.
  • Culture of pleural fluid identified Enterococcus faecalis.
  • Successful treatment with drainage, antibiotics, and fibrinolysis resulted in full recovery and lung re-expansion without surgery.

Conclusions:

  • Enterococcus faecalis can cause empyema in immunocompetent patients.
  • Early recognition, image-guided drainage, antibiotics, and fibrinolysis are effective treatments.
  • Favorable outcomes can be achieved, potentially avoiding invasive surgical procedures.
Keywords:
Empyemafibrinolyse intrapleuraleinfection pleuraleintrapleural fibrinolysispleural infection

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