An Unusual Case of Renal Abscess Caused byStreptococcus pneumoniae

tion toward Edwardsiella tarda bacteremia in individuals with preex-wardsiella tarda: a case report and review of the literature. and clindamycin phosphate; 1 day later, treatment was changed to cefazolin sodium (1 g every 8 hours). His temperature decreased The most common manifestation of pneumococcal disease is except for an occasional elevation. On hospital day 2, an abdominal pneumonia, which has been associated with local complications CT showed an abscess affecting the lower pole of the right kidney (empyema, pericarditis, lung abscess), extrapulmonary infections (figure 1). A percutaneous drainage tube was placed into the ab-(otitis media, sinusitis, meningitis), or less-common extrapulmo-scess on hospital day 4. Cultures of the abscess and concomitant nary infections (endocarditis, septic arthritis, and peritonitis) [1]. blood cultures yielded oxacillin-susceptible S. pneumoniae. Be-Streptococcus pneumoniae has also been associated with soft-cause of incomplete drainage, a second percutaneous tube was tissue infections (cellulitis, fasciitis, and abscess), especially in placed on hospital day 11. patients with connective tissue disease [2, 3]. Scott and Schmidt The patient became afebrile on hospital day 6. An echocardio-[4] described psoas muscle abscess caused by S. pneumoniae. Pyo-gram did not reveal any clinically significant findings or any evi-genic abscess of the gluteal muscle due to S. pneumoniae has dence of definite valvular vegetation. He was treated first with iv been also been reported [5]. Patients infected with HIV have an cefazolin for 12 days, and he then received oral cephalexin alone increased frequency of invasive pneumococcal disease, although for 4 weeks. He recovered fully without long-term complications. Janoff et al. [6] found that HIV-infected patients had symptoms When last seen 1 year after treatment, the patient was doing well. and signs that were similar to those in healthy hosts. This case was unusual because the primary disease process was A 50-year-old man with an unusual type of S. pneumoniae infec-probably a renal abscess (no other foci of infection were noted), tion was treated at our facility. He had a history of type II diabetes whereas extrapulmonary pneumococcal infection most often me-that had been treated with oral medication. He complained of tastasizes from the lung. Moreover, the patient had no evidence of abdominal distention, nausea, vomiting, and fever that had begun respiratory disease or pneumonia and instead had fever, abdominal 6 weeks before admission to the hospital; night sweats and chills discomfort, and weight loss. also developed sometime before admission. At each of several A review of …