Streptococcus Intermedius Liver Abscess and Pyogenic Spondylitis in a Patient with Hemangioma of the Small Intestine

Abstract

Liver abscesses caused by members of the Streptococcus anginosus group, part of the oral microbiome, have been increasingly reported in recent years, and investigation of the upper, as well as the lower, gastrointestinal tract is now emphasized. A 68-year-old woman presented with lumbar pain and a fever (temperature ≥40 °C). On investigation, multiple liver abscesses and pyogenic spondylitis were diagnosed, and antibiotic treatment was started. Lower and upper gastrointestinal endoscopies were both unremarkable. Contrast-enhanced computed tomography showed contrast-enhanced irregular thickening of the wall of the small intestine, and Streptococcus intermedius was detected on blood culture. Since this suggested the possibility of bacterial entry via a small intestinal lesion, small bowel endoscopy was conducted, but the lesion was not definitively identified. Laparoscopic partial small bowel resection was conducted on postadmission day 19 with the aims of controlling the bacterial entry portal and diagnosis of the small intestinal tumor. On pathological examination, a cavernous hemangioma with longitudinal ulceration of the intestinal mucosa, findings consistent with this being the entry portal, was found. This case suggests that investigation of the entire gastrointestinal tract, including the small intestine, is important if the causative microorganism is a member of the Streptococcus anginosus group.