Pleural Enterococcus faecalis empyema: an unusual case.

A 63-year-old female patient was admitted to the department of neurology following an acute ischemic infarction of the right medial cerebral artery. She developed fever, respiratory failure, and hypotension and had to be transferred to the intensive care unit (ICU) for intubation and mechanical ventilation. Chest X-ray showed increased density of the complete right hemi-thorax, indicative of massive pleural effusion. Chest tube drainage produced 1.5 l of pus in 1 h. Cultures revealed growth of Enterococcus faecalis. The patient was treated with amoxicillin and clavulanic acid with good clinical response. Enterococci very rarely cause spontaneous pleural empyema. The natural resistance of enterococci to several types of antibiotics can lead to selection of enterococci as seen in other clinical studies and may lead to this unusual clinical consequence.