Peña-Garcia J Isaac, Shaikh Sana, Lacasse Alexandre
Department of Internal Medicine, SSM St. Mary's Hospital - St. Louis, St. Louis, MO, USA.
J Community Hosp Intern Med Perspect. 2018 Apr 17;8(2):76-79. doi: 10.1080/20009666.2018.1433431. eCollection 2018.
Group B streptococcus infections (GBSI) are commonly associated with neonates and pregnant women, but may also affect nonpregnant adults. Among its spectrum of manifestations, perinephric abscess (PA) is exceedingly rare. Comorbid conditions such as diabetes mellitus (DM) and immunosuppression increase the risk of GBSI. We describe a 61-year-old Vietnamese man with compensated alcoholic cirrhosis, who presented with acute encephalopathy following subacute, progressive abdominal pain. He was afebrile and hemodynamically stable. Laboratory data were remarkable for leukocytosis, thrombocytopenia, azotemia, and pyuria. He was found to have two right-sided PA measuring 15 × 10 × 11 cm and 4.6 × 2.7 × 7.8 cm, requiring interval placement of multiple percutaneous drains. Culture from abscesses revealed beta-hemolytic Group B streptococcus (GBS). His course was complicated by contiguous spread to abdominal wall and paraspinal musculature, as well as a new diagnosis of type 2 DM. Along with drainage, a prolonged course of intravenous antimicrobial treatment led to abscess resolution. Given the rising number of unusual clinical presentations of GBSI, this bacteria should be considered as a part of the microbiological differential diagnosis of PA, especially in conditions leading to immunosuppression.
B族链球菌感染（GBSI）通常与新生儿和孕妇有关，但也可能影响非孕妇成年人。在其一系列表现中，肾周脓肿（PA）极为罕见。糖尿病（DM）和免疫抑制等合并症会增加GBSI的风险。我们描述了一名61岁的越南男子，患有代偿性酒精性肝硬化，在亚急性进行性腹痛后出现急性脑病。他无发热，血流动力学稳定。实验室检查结果显示白细胞增多、血小板减少、氮质血症和脓尿。发现他右侧有两个肾周脓肿，大小分别为15×10×11厘米和4.6×2.7×7.8厘米，需要多次经皮放置引流管。脓肿培养显示为β溶血性B族链球菌（GBS）。他的病情因脓肿蔓延至腹壁和椎旁肌肉组织而复杂化，同时还新诊断出2型糖尿病。除了引流外，延长静脉抗菌治疗疗程使脓肿消退。鉴于GBSI不寻常临床表现的数量不断增加，这种细菌应被视为肾周脓肿微生物鉴别诊断的一部分，尤其是在导致免疫抑制的情况下。
