Lauren T. Gallagher, BS1, Rawan Dayah, MD2, Sidra Qureshi, MD1
1University of Texas Medical Branch, Galveston, TX; 2The University of Texas Medical Branch, Galveston, TX
Introduction: Organisms of the Streptococcus anginosus group consists of three distinct streptococcal species: Streptococcus intermedius, Streptococcus constellatus, and Streptococcus anginosus. These organisms are commonly associated with abscesses, but polymicrobial infections in the setting of an immunocompromised patient can infrequently cause bacteremia. Here we report the case of a 37-year-old male with Crohn’s disease who was found to have bacteremia secondary to a perianal abscess due to a co-infection of Streptococcus constellatus and Parvimonas micra.
Case Description/Methods: A 37-year-old male with Crohn’s disease who presented with fever, leukocytosis and rectal pain was found to have bacteremia due to a polymicrobial infection of Streptococcus constellatus and Parvimonas micra. A CT abdomen and pelvis performed excluded any acute abdominopelvic disease. A MRI was done to determine a source of infection which showed a left perianal abscess measuring 3.2 x 1.6 x 4.7 cm. Our patient underwent an examination under anesthesia with biopsy, anoscopy and surgical drainage with seton placement. He received intravenous antibiotic therapy with Ceftriaxone and Metronidazole for three days and was discharged on a two week course of oral Augmentin after two repeat blood cultures were negative. Patient continues to have the seton drain in place six months from surgery with no complications or reoccurrence of infection.
Discussion: This case report sheds light on a rarely described pathogen causing bacteremia and provides a comprehensive approach to diagnosis and management. S. constellatus is a common cause of abscesses in the alimentary tract but rarely causes infection in blood. Co-infection with an anaerobe in the setting of an immunocompromised individual such as Crohn's disease increases the likelihood for blood infections. Bacteremia from this group must prompt evaluation for possible intra-abdominal abscess, deep-seated head and neck infection, brain abscess and endocarditis to determine the underlying source of infection. Treatment of infections due to the S. anginosus group consist of abscess drainage and antimicrobial therapy with Ceftriaxone being the preferred agent.
Citation: Lauren T. Gallagher, BS; Rawan Dayah, MD; Sidra Qureshi, MD. P1442 - A RARE CASE OF S. CONSTELLATUS BACTEREMIA SECONDARY TO A PERIANAL ABSCESS IN AN INDIVIDUAL WITH CROHN'S DISEASE. Program No. P1442. ACG 2019 Annual Scientific Meeting Abstracts. San Antonio, Texas: American College of Gastroenterology.