DOI: http://dx.doi.org/10.18203/2320-6012.ijrms20211375

Streptococcus anginosus bacteremia: a septic IVC thrombus and a large empyema requiring decortication

Niaz A. Shaikh, Ayesha H. Alshamsi, Khalid O. Alattar, Jehangir A. Mobushar, Ranjana Pradeep, Asma AlQasmi, Naima Mustafa, Hebah M. Sabri

Abstract


A previously healthy 39 year old male presented with complaints of cough, fever, abdominal pain and chills. The patient was found to be in active sepsis with hypotension on presentation so was resuscitated while a full septic work-up was ordered. Initial chest X-ray showed only increased broncho-alveolar markings and no consolidations, but blood cultures eventually revealed Streptococcus anginosus bacteremia. Intravenous antibiotics were started and infective endocarditis was ruled out. Computerized tomography scan of the abdomen with contrast revealed findings suggestive of a septic hepatic inferior vena cava thrombus and right lower lung findings suggestive of septic embolization and an empyema. Later on during admission, CT scan of the chest with contrast revealed a moderate-sized empyema of the right lung which eventually required decortication. Discovering such findings concurrently in a single patient is extremely rare, particularly an embolizing septic IVC thrombus with confirmed bacteremia. For this reason it is described in the following case presentation


Keywords


Anginosus, Milleri, Bacteremia, Emboli, Empyema, Decortication

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References


Esplin N, Stelzer J, All S, Kumar S, Ghaffar E, Ali S. A case of streptococcus anginosus brain abscess caused by contiguous spread from sinusitis in an immunocompetent patient. Cureus. 2017;9(10):1-11.

Giuliano S, Rubini G, Conte A, Goldoni P, Falcone M, Vena A, et al. Streptococcus anginosus group disseminated infection: case report and review of literature. Infez Med. 2012;20(3):145-54.

Erdem I, Dogru M, Emir S, Ali R, Elbasan S, Mutlu R, et al. Unusual Presentation of Streptococcus anginosus With Severe Sepsis, Liver Abscess Secondary to Biliary Tract Perforation. J Med Cases. 2015;6(11):508-11.

Al-Saffar F, Torres-Miranda D, Ibrahim S, Shujaat A. How an opportunistic infection can mess with your brain and take your breath away: a rare case of simultaneous lung and brain abscess due to streptococcus anginosus. Case Rep Infect Dis. 2015;2015:1-3.

Jimenez J, Vahdat K, Santiago I, Hernandez M, Isache C, Sands M. Thalamic bacterial abscess presenting with hemiparesis and expressive aphasia. ID Cases. 2018;13(417).

Rawla P, Vellipuram A, Bandaru S, Raj J. Colon carcinoma presenting as streptococcus anginosus bacteremia and liver abscess. Gastroenterol Res. 2017;10(6):376-9.

Palacio F, Lewis J, Sadkowski L, Echevarria K, Jorgensen J. Breakthrough bacteremia and septic shock due to streptococcus anginosus resistant to daptomycin in a patient receiving daptomycin therapy. Antimicrob Agents Chemother. 2011;55 (7):3639-40.

Finn T, Schattner A, Dubin I, Cohen R. Streptococcus anginosus endocarditis and multiple liver abscesses in a splenectomised patient. BMJ Case Rep. 2018;224-66.

Madrid-Carbajal C, Molinos L, GarcĂ­a-Clemente M, Pando-Sandoval A, Fleites A, Casan-Clara P. Pleural effusion due to streptococcus milleri: case descriptions. Arch de Bronconeumol. 2014;50(9): 404-6.

Haidar A, Haddad A, Naqvi A, Onyesoh N, Malik R, Williams M. Streptococcus constellatus causing septic thrombophlebitis of the right ovarian vein with extension into the inferior vena cava. Case Rep Infect Dis. 2015;2015:1-5.