Group B streptococcal cellulitis in an adult

A 75-year-old man with stage IV chronic lymphocytic leukemia was seen for tingling in the left arm, vesicular rash confined to the dorsum of the left hand, and diffuse erythema and swelling that extended to the elbow. Gram's stain of material aspirated from the cellulitic area revealed gram-positive cocci. Blood cultures grew group B streptococci, and cultures of material from the cellulitic area grew group B streptococci and Staphylococcus aureus. Cellulitis with bacteremia was diagnosed, and seven-day drug therapy with acyclovir (Zovirax) and penicillin G was started. The cellulitis resolved and the vesicular lesions crusted over within seven days. Group B streptococci, traditionally regarded as pathogens of neonates, are becoming an increasingly important cause of infection in adults. Primary care physicians who care for adults, especially those who are elderly, should include group B streptococci in the differential diagnosis of cellulitis.