Cerebral hemorrhage, splenic and renal embolisms due to infective endocarditis

Splenic abscess caused by Streptococcus anginosus bacteremia secondary to urinary tract infection: a case report and literature review

Organ abscesses caused by Streptococcus anginosus are relatively rare. We report the case of an elderly woman with splenic abscess caused by S. anginosus bacteremia after urinary tract infection. An 82-year-old woman had a history of frequency of urination, urgency, and fever with chills for over 10 days prior to admission. An abdominal computed tomography (CT) scan performed in the emergency room revealed a low-density lesion in the spleen, kidney cysts, some exudation around the kidney, and cystitis should be valued. She was treated with ceftriaxone and imipenem/cilastatin. After admission, the blood culture yielded positive results for S. anginosus. A contrast-enhanced abdominal CT scan showed that the low-density lesion previously found in the spleen was smaller than before. After percutaneous drainage of the splenic abscess and treatment with piperacillin/tazobactam based on the antibiotic sensitivity pattern, repeated abdominal CT scan revealed a significant reduction in the low-density lesion. The patient was discharged without recurrence or complications. A systematic review of organ abscess caused by S. anginosus bacteremia was performed. To our knowledge, there has been no report of splenic abscess caused by S. anginosus bacteremia secondary to urinary system tract infection, although urinary tract infections are also an important source.

Infective endocarditis presenting with loin pain

A 28-year-old previously healthy man presented to a peripheral hospital several hours after onset of acute right flank pain. A kidney stone was suspected clinically as the patient was otherwise well appearing, afebrile and normotensive. Renal function was normal and urinalysis showed no haematuria or white blood cells. A contrast CT scan of the abdomen revealed a filling defect in the ventral branch of the right renal artery with no distal perfusion suggesting a renal embolus. Subsequent investigations revealed blood cultures positive for coagulase negative staphylococcus and echocardiogram showed a bicuspid aortic valve, a dilated aortic root and moderately dilated ascending aorta. The patient was transferred to a tertiary care hospital and transesophageal echocardiogram revealed severe aortic insufficiency and thickening of the aortic valve suggestive of endocarditis. Following antibiotic treatment, blood cultures became negative and the patient underwent successful semi-urgent aortic root replacement. Renal function remained normal throughout.