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Septic shock from multiple intra-abdominal Streptococcus constellatus abscesses unamenable to percutaneous drainage
Faraz Badar1, Aqsa Ashraf1, Shaheryar Usman1
1Department of Pulmonary and Critical Care, Zucker School of Medicine at Hofstra/Northwell - Mather Hospital, New York, USA.
Abstract:
Streptococcus constellatus are gram-positive cocci belonging to the Streptococcus milleri group that have a propensity to cause bacteremia and abscesses, especially in immunocompromised patients. Here, we report the case of a 39-year-old male who was initially admitted to the hospital for diabetic ketoacidosis. During the hospitalization, he developed sepsis and blood cultures grew Streptococcus constellatus. CT imaging revealed multiple hepatic abscesses. A periapical abscess of the left mandibular central incisor found on CT Scan of face was identified as the likely source of infection. IR-guided drainage was performed however the patient went on to develop septic shock despite attempted source control and IV antibiotic therapy. Repeat imaging showed persistent hepatic abscesses in addition to new intraperitoneal abscesses necessitating exploratory laparotomy, drainage and abdominal washout. Fluid cultures grew Streptococcus constellatus and common enteric flora. Our report highlights the need for high clinical suspicion in cases of Streptococcus constellatus bacteremia to obtain diagnostic imaging for any abscess formation. Prolonged antibiotic therapy is a must and imaging guided or surgical drainage may be needed.
Insights
Streptococcus constellatus can cause severe infections like bacteremia and abscesses, particularly in immunocompromised individuals. Prompt diagnosis and aggressive management, including drainage and prolonged antibiotics, are crucial for patient outcomes.
Area of Science:
- Medical Microbiology
- Infectious Diseases
- Clinical Case Study
Background:
- Streptococcus constellatus, part of the Streptococcus milleri group, is known to cause bacteremia and abscesses.
- Immunocompromised patients are particularly susceptible to severe infections caused by this bacterium.
Observation:
- A 39-year-old male with diabetic ketoacidosis developed sepsis with Streptococcus constellatus bacteremia.
- CT imaging revealed multiple hepatic abscesses, with a periapical dental abscess identified as the likely source.
- Despite initial drainage and antibiotics, the patient progressed to septic shock with new intraperitoneal abscesses.
Findings:
- Surgical intervention, including exploratory laparotomy and abdominal washout, was required for persistent and new abscesses.
- Blood and fluid cultures confirmed Streptococcus constellatus and common enteric flora.
- The case underscores the challenges in managing complex Streptococcus constellatus infections.
Implications:
- High clinical suspicion for Streptococcus constellatus bacteremia is essential to guide diagnostic imaging for abscesses.
- Effective management necessitates prolonged antibiotic therapy and may require image-guided or surgical drainage.
- This case highlights the importance of source control in preventing severe outcomes like septic shock.
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