Title : Surviving a rare, multifocal musculoskeletal infection with concomitant septic myocarditis from S. dysgalactiae bacteremia in a 50-year-old male Filipino: A case report
Abstract:
Background: Streptococcus dysgalactiae (SD) is an uncommon human pathogen and its invasive course and clinical outcomes remain unknown. Bacteremia due to SD with systemic complications is rare with an incidence rate of 7/100,000, and survival in such cases is even rarer. Here, we report a unique case of disseminated SD infection with multi-organ involvement who survived despite extensive disease burden.
Case: We report a case of a 50-year-old male who initially presented with fever, severe bilateral upper and lower extremity pain, and new onset heart failure. Blood cultures taken showed growth of Streptococcus dysgalactiae, hence IV Penicillin G was initiated. With increasing myalgia, patient developed acute rhabdomyolysis secondary to infectious myositis. Severe bacteremia eventually led to polyarticular arthritis, hence patient underwent knee arthrocentesis. Culture showed growth of SD – confirming septic arthritis, hence a STAT bilateral arthrotomy with synovectomy was performed. Further work up showed an incidental finding of a 7.0x4.1x9.0 cm organized abscess in the left gluteus medius. Patient succumb to ARDS, but eventually recovered. Repeat cultures showed clearing of the bacteremia and septic cardiomyopathy from SD bacteremia was confirmed with the reversal of the new onset heart failure upon full recovery.
Discussion: Streptococcus dysgalactiae (SD) is a gram-positive coccus that belongs to the Lancefield group C/G streptococci. Data on SD bacteremia is scarce due its rare incidence, which hinders timely diagnosis and contributes to high mortality rate. Polyarticular septic arthritis from SD bacteremia accounts a 50% mortality rate - but with only 3 documented cases at present. Only 1 case of infectious myositis with muscular abscess formation from SD infection is reported - adding to the difficulty in identifying this disease complication. No documented cases of SD septic cardiomyopathy is reported, making this case an addition this bacteria’s invasive potential.
Conclusion: This case adds to the limited literature on SD invasive infection and clinical presentation. Further studies and systematic reporting are essential to better define the disease spectrum for this uncommon yet potentially life-threatening pathogen.
