Atypical Empyema From a Typically Benign Bug

Empyema is a complication of pneumonia, characterized by pus accumulation in the pleural space. It is more common in patients with comorbidities such as older age, diabetes, cancer, or immunocompromised states. Aspiration or oral cavity infections are more common in older adults with significant risk factors; therefore, the pathogen <i>Streptococcus constellatus</i> is usually rare. <i>S. constellatus</i> is mainly known for its ability to produce abscesses and pyogenic invasive infections, with most of the infections being found in the orofacial and gastrointestinal regions. The patient is a 58-year-old female who presented with weakness, fatigue, nausea, anorexia, diarrhea, and subjective fever for two weeks. Investigation revealed that there was left-sided empyema, and the pleural fluid grew <i>S. constellatus</i> on culture. The management included antibiotics, chest tube drainage, and finally decortication. The patient's recovery further demonstrates how rare and complex empyema caused by <i>S. constellatus</i> is in a healthy person.