Background: Streptococcus sanguis comprises part of the normal flora of the human oral cavity. Although it has been recognized increasingly as an important pathogen of endocarditis, S. sanguis is a rare cause of urinary and iliopsoas abscess. Case Presentation: An 81-year-old male presented to the emergency department with complaints of pain in the right side of his back and gait disturbance. Laboratory results revealed slightly elevated inflammatory markers, moderately elevated renal function, and severe anemia. Computed tomography revealed right hydronephrosis and swollen iliopsoas. Ultrasonography revealed a distended right ureter that was affected by low echoic lesion in the iliopsoas. Iliopsoas abscess was suspected based on imaging results. In addition to administration of an antibacterial antibiotic, percutaneous drainage of the abscess was performed. Cultures of samples taken from the abscess and urine cultures were positive for S. sanguis. Fever and inflammatory reaction improved after drainage and antibiotic treatment. Three weeks after drainage, the patient had recovered uneventfully and returned home. Conclusion: It is important to recognize S. sanguis as a previously unrecognized species of Streptococcus in the etiology of iliopsoas abscess and to be aware of its predisposing factors. Sharing our experience with readers may help clinicians make the proper selection of antimicrobial agents, a key to the successful management of iliopsoas abscess.
Background: Pyrogenetic liver abscess is often caused by gram-negative bacilli, including Escheria coli or Klebsiella pneumoniae, but rarely by Streptococcus constellatus. Streptococcus constellatus is a commensal of the oral cavity, respiratory tract system, intestine, and urogenital organs. Herein, we report a case of multiple liver abscesses caused by Streptococcus constellatus. Case Presentation: A 66-year-old male presented with a high-grade fever with no known source. Laboratory analysis revealed severely elevated inflammation levels, moderately increased liver and biliary enzymes, and moderately worsened renal function. Sonazoid Ò (GE Healthcare AS, Oslo, Norway)-enhanced sonography revealed marginally contrast-enhanced masses with a non-contrastenhanced center. On the basis of these results, the patient was diagnosed with multiple liver abscesses. Subsequently, meropenem 1 g/d was prescribed. On day two, percutaneous abscess drainage was performed. Culture from abscess drainage and blood culture revealed the presence of Streptococcus constellatus. Because of antibiotic sensitivity, meropenem was replaced by piperacillin 6 g/d. Clinical course was uneventful and the patient was discharged on day 53. Conclusion: The pathogenic potential of Streptococcus constellatus has been recognized recently. Although the Streptococcus milleri group has been focused on primarily for its commensal nature, clinicians need to be aware of its pathogenic nature and biologic character of forming liver abscesses.
Background: Non-invasive positive-pressure ventilation (NIPPV) is a useful tool, especially for patients with respiratory failure. Although NIPPV is accepted now as harmless and comfortable treatment tools for patients, the associated equipment can induce a critical illness if expiratory pressure is not adjusted adequately. Case: A 23-year-old male was admitted to our hospital complaining of severe abdominal pain. He had a history of congenital hypomyelination neuropathy. Because of respiratory insufficiency due to neuropathy, his doctor had prescribed NIPPV and increased end expiratory pressure three months earlier. Because abdominal computed tomography (CT) revealed ascites and pneumoperitoneum indicating gastrointestinal perforation, emergent laparotomy was performed. Intra-operative findings showed a gastric perforation and hematoma at the gastric anterior walls. The patient recovered from post-operative bowel obstruction and was transferred to pediatrics on post-admission day 26. Conclusion: Although gastrointestinal complications associated with NIPPV are rare, clinicians should be aware of possible life-threatening adverse events of the gastrointestinal rupture due to high respiratory pressure support.
Background: Necrotizing fasciitis is an infection of the soft tissue marked by quickly spreading inflammation and subsequent necrosis of the skin, subcutaneous fat, muscle fascia, and in some cases, the epidermidis, associated with a fulminating septic process. Mortality is high without immediate surgical intervention. We report a case of a female exhibiting primary necrotizing fasciitis that was treated with a combination of conservative surgery and negative-pressure wound therapy. Case Presentation: A 78-year-old female was admitted to our emergency department complaining of left inguinal pain for two days. On arrival, the patient had an extensively spreading, well-demarcated section of purplish discoloration with associated skin peeling over her left lower abdomen and inguinal lesion. A diagnosis of sepsis secondary to necrotizing fasciitis of the left inguinal area was made. She was started immediately on empirical broad-spectrum antibiotics and surgical debridement of the necrotic tissue. Surgical incision culture was positive for Streptococcus pyogenes (group A b-hemolytic Streptococcus). In addition to using a device to divert stool, negative-pressure wound therapy was applied to the large open wound that successfully helped with wound bed cleansing, which was followed by skin grafting surgery. The patient recovered uneventfully. Conclusion: We treated a patient with acute necrotizing fasciitis by surgically removing the necrotized tissues, systemically administering broad-spectrum antimicrobial agents, and ameliorating underlying systemic disease processes. Negative-pressure wound therapy prior to definitive surgical management of skin grafting was effective in managing open surgical incisions resulting from surgical treatment for a patient with necrotizing fasciitis. Additionally, the Flexi-Seal Ò device (ConvaTec, Inc., Greensboro, NC) helped keep the wound clean and dry.
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