CASE REPORT   

Gazzetta Medica Italiana - Archivio per le Scienze Mediche 2019 October;178(10):854-8

DOI: 10.23736/S0393-3660.18.03995-5

Copyright © 2018 EDIZIONI MINERVA MEDICA

lingua: Inglese

Elderly man with Streptococcus anginosus bacteremia: diagnostic and therapeutic approach

Antonio FARAONE ✉, Alberto FORTINI

Unit of Internal Medicine, Medical Department, San Giovanni di Dio Hospital, Florence, Italy

The Streptococcus anginosus group (SAG) consists of 3 distinct species of streptococci (Streptococcus anginosus, Streptococcus constellatus, Streptococcus intermedius) characterized by a unique propensity to produce pyogenic infections with abscess formation. SAG bacteremia is almost always secondary to a focal infection and warrants a thorough search for an underlying suppurative process. We report a case of S. anginosus bacteremia secondary to a liver abscess in an elderly man. The patient presented with a 2-day history of fever, vomiting and altered mental status. Laboratory tests showed elevated sepsis biomarkers and hepatobiliary enzymes. The patient was empirically started on IV piperacillin/tazobactam. Blood cultures grew S. anginosus, prompting us to perform additional diagnostic tests. Abdomen CT scan revealed an abscess of the hepatic segment 4, along with pylephlebitis. The abscess was drained percutaneously and bacteriological culture confirmed S. anginosus. The patient was switched to IV ceftriaxone (10 days), followed by oral amoxicillin (2 weeks), experiencing complete clinical recovery. Colonoscopy showed left colonic diverticulosis as potential source of hepatic infection.

KEY WORDS: Streptococcus anginosus; Bacteremia; Liver abscess