Retroperitoneal infection associated with Streptococcus dysgalactiae subsp. equisimilis bacteremia and lower-extremity cellulitis: a case report.
Tokuo Fujisawa
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Case in brief
A 70-year-old man with diabetes and alcoholic liver disease presented with fever and septic shock. Initial imaging revealed retroperitoneal lymphadenopathy and inflammatory changes, with subsequent identification of right lower-leg cellulitis. Blood cultures confirmed Streptococcus dysgalactiae subsp. equisimilis bacteremia. The patient improved with antimicrobial therapy, which was stopped after 15 days following bacteremia clearance. At 3 months, retroperitoneal lesions resolved without relapse.
What made this case unusual
This case highlights the rare association of Streptococcus dysgalactiae subsp. equisimilis bacteremia with retroperitoneal lymphatic involvement stemming from lower-extremity cellulitis.
Diagnostic / clinical pearl
Clinicians should consider the potential for retroperitoneal lymphatic involvement in cases of cellulitis caused by Streptococcus dysgalactiae subsp. equisimilis.
Why it matters
Understanding this association may influence the management of similar infections, particularly regarding the duration of antimicrobial therapy in the absence of abscess formation or persistent infection.