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 <i>Streptococcus constellatus</i>, 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 <i>S. constellatus</i>. 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 <i>S. constellatus</i> 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.