Streptococcus intermedius: unusual presentation and complication of lung abscess

We report a case of a 54-year-old immunocompetent male who had lung abscess secondary to Streptococcus intermedius that led to discitis by contiguous spread of infection. He initially presented with constant chest pain for 6 weeks that radiated to lower back, with no fever, chills or weight loss. He denied smoking cigarettes, alcohol use or any illicit drug. On investigation, a mass was identified on the posterior medial aspect of the right lower lobe with direct infiltration into right side of the T5-T6 vertebral bodies. Histopathology identified organising pneumonia with abscess. Tissue cultures showed S. intermedius, and were negative for other microorganisms. This case highlights a rare presentation of S intermedius discitis by contiguous spread of infection from posterior right lower lobe lung abscess. S intermedius usually occurs in older patients with pulmonary infections complicated with pleural effusion or lung abscess, but can present in young patients with no clear symptoms of lung infection, like our patient.