STREPTOCOCCUS ANGINOSUS BACTEREMIA CAUSING SEPTIC SHOCK WITH HEPATIC ABSCESS

Abstract

SESSION TITLE: Pulmonary Manifestations of Systemic Disease Posters SESSION TYPE: Original Investigation Posters PRESENTED ON: October 18-21, 2020 PURPOSE: Septic shock is one of the common presentations for ICU admissions in the U.S. Rarer organisms such as Streptococcus anginosus should be on the spectrum of differentials while looking for causes of sepsis. METHODS: A 71 year old male with past history of colon cancer, melanoma, hypertension and coronary artery disease status post stent placement presented with one month history of cough, shortness of breath, and hypoxia. Over the last month, he was on weaning doses of prednisone, had associated syncope, weakness, and falls. Review of symptoms was positive for fatigue, fever, sweats, chills and weakness. Home medications include prednisone 10mg and 3 antihypertensive medications. On exam, the patient was stable but appeared ill. His vital signs were: blood pressure 78/57 mm Hg, heart rate 123 beats per minute, respiratory rate of 24 breaths per minute, temperature of 38.9 Celsius and oxygen saturation 88% on room air. Exam was unremarkable except tachycardia, decreased breath sounds on right lung and his skin appeared pink, warm and diaphoretic with normal capillary refill. RESULTS: This patient initially appeared to be in septic shock. He was started on oxygen 2 Liters via nasal cannula, IV fluids 30 ml/kg, blood/sputum cultures, urine legionella and strep pneumonia antigens and MRSA screening were done. EKG showed sinus tachycardia with ventricular rate of 117. Patient was then placed on vancomycin, zosyn, and azithromycin. Due to persistent hypotension secondary to septic shock, norepinephrine was started. He was admitted to the intensive care unit. Blood work showed acute kidney injury with transaminitis, increase alkaline phosphate and hypoalbuminemia. His lactate, procalcitonin, troponin, B-type natriuretic peptide were abnormally high. Computed tomography of his chest showed right lower lobe, middle lobe consolidation surrounding areas of ground-glass in a “reversed halo” pattern. A hypodense lesion in the liver was also evident on the CT. Ultrasound of the abdominal was equivocal. Interventional radiology successfully drained 160 ml of purulent fluid from a 7 cm liver abscess. Blood cultures grew Streptococcus anginosus group. The patient was started on 6 weeks of IV ceftriaxone. The patient’s septic shock improved, and he was transferred to the floor. CONCLUSIONS: Streptococcus anginosus is a rare cause of septic shock and commonly associated with solid tumors especially GI malignancy. It differs from other streptococcal groups by its ability to form abscesses. Ceftriaxone remains to be the treatment of choice along with drainage of abscesses. CLINICAL IMPLICATIONS: Streptococcus anginosus is a rare cause of sepsis that should always be on the differentials especially in patients with malignancies. DISCLOSURES: No relevant relationships by Sai Swapnika Guttikonda, source=Web Response No relevant relationships by Benjamin Silverman, source=Web Response No relevant relationships by INTEKHAB ASKARI SYED AHMAD RAZA, source=Web Response