Introduction: Lactobacilli are common commensal bacteria found in the gastrointestinal and genitourinary tract. Although they are usually thought to be non-pathogenic, there have been few reported cases that showcase severe infections caused by these microorganisms. This is the first reported case of a bilateral empyema with bacterial cultures growing only Lactobacillus gasseri in the setting of undiagnosed type 2 DM. Case description: Previously healthy 49-year-old male, presented to the emergency room with a 3 month history of a productive cough and worsening fatigue that was associated with a 30 pound weight loss and bilateral lower extremity edema. He denied any smoking history, history of recent or recurrent pneumonia or sick contacts. Upon presentation, he was hypoxic and tachycardic. On physical examination patient appeared cachectic, right lung sounds were diminished and lower extremities showed 2 to 3þ pitting edema. Results and conclusions: White count was 23.8x10(9)/L, Hemoglobin A1c is 14.7%. HIV test negative. CT-chest showed a large right sided pleural effusion containing pockets of gas consistent with empyema, along with focal airspace disease within the lingual and left lower lobe. Patient underwent a right sided VATS procedure and two chest tubes were placed. Intraoperatively 1300mL of gray foul-smelling material was drained. Repeated CT-chest showed left lung consolidation and effusion and a chest tube was placed on hospital day 8. Cultures were positive for Lactobacillus gasseri from both lungs. Patient was treated with Ampicillin/Sulbactam followed by a course of Amoxicillin/clavulanic acid. Take-home message: Lactobacillus gasseri is an unusual cause of empyema. Management requires adequate drainage.