Abstract Details

Title Acute Disseminated Streptococcus Anginosus Abscesses in a Young Immunocompetent Patient

Topic Infectious Disease

Presentation(s) P5 - Poster Session 5 (5:30 PM-6:30 PM)

Poster/Presentation
Number 4-004

Objective NA

Background Streptococcus anginosus is a motile, facultative anaerobe that exists as a normal part of the human oral and gastrointestinal flora. It has a predilection to form pyogenic infections in the liver, lungs and central nervous system through either contiguous or hematogenous spread.

Design/Methods A 34 year-old healthy man presented with acute onset of headache, photophobia and encephalopathy. Lumbar puncture revealed cloudy fluid with WBC 26,000 cells/uL with neutrophilic predominance, RBC 1000 cells/uL, glucose 19 mg/dL and protein 330 mg/dL without organism identified on gram stain or PCR. Cerebrospinal fluid and blood cultures yielded no growth. HIV was negative. MRI brain showed numerous bilateral cerebral abscesses with ependymitis of the occipital horn of the right lateral ventricle. Patient underwent abscess drainage where OR cultures grew Streptococcus anginosus sensitive to ceftriaxone. Further CT imaging was pursued to further evaluate the source of infection which did not demonstrate evidence of liver or intra-adombinal abscess, but revealed a cavitating lesion in the right upper lung. CTA chest and TEE did not show evidence of pulmonary AVM or PFO. However, thoracic spine MRI revealed an occult intramedullary abscess at levels of T5-T6. He was treated with IV ceftriaxone for 6 weeks with improvement in his clinical symptoms and repeat imaging.

Results NA

Conclusions We present a case of a previously healthy young patient who presented with meningoencephalitis and found to have disseminated Streptococcus anginosus abscesses throughout the CNS. This case highlights the insidious presentation of a potentially fatal infection, the importance of brain and spine imaging and early antibiotic treatment to prevent debilitating complications.

Authors/Disclosures
Jane Khalife, MD (Thomas Jefferson University Hospital) PRESENTER	Dr. Khalife has nothing to disclose.
Connie G. Tang, MD (Lehigh Valley Health Network)	Dr. Tang has nothing to disclose.
Matthew Bokhari, MD (NYU Long Island)	No disclosure on file

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