Enterococcus faecalis causing empyema in a patient with liver disease.

A 57-year-old man with a history of liver disease had shortness of breath, fever, and pleuritic chest pain. Ascites was not present. Computed tomography (CT) of the chest revealed a large unilateral pleural effusion, compressive atelectasis, and no evidence of consolidation. Culture of the pleural fluid grew Enterococcus faecalis. Treatment with ampicillin in conjunction with tube thoracostomy resulted in clinical improvement. This case illustrates the development of spontaneous monomicrobial empyema due to E. faecalis in a patient with liver disease, in the absence of pneumonia and peritonitis.