JOURNAL OF THE LOUISIANA STATE MEDICAL SOCIETY
Group G Streptococcal Bacteremia Secondary to a BurnWound Infection Paige Deichmann; Amol Sura; Charles Sanders, MD; Nisha Aravindakshan-Patel, MD; Fred Lopez, MD CLINICAL CASE OF THE MONTH CASE PRESENTATION IMAGE 1: Right forearm with second degree partial thickness burns.
IMAGE 2: Right hand with second degree partial thickness burns and ruptutred blisters.
A 61-year-old man presented to the emergency department with second degree burns along his right arm and hand. He reported that his knees suddenly gave out while holding a pot of soup resulting in the scalding liquid spilling over his arm. His medical history is significant for alcohol abuse, chronic obstructive pulmonary disease, atrial fibrillation, congestive heart failure with preserved ejection fraction, chronic knee instability, and degenerative joint disease of the spine. Vital signs revealed a temperature of 101.5°F, pulse 110/minute, blood pressure 123/83 mmHg, respiratory rate of 21/minute and oxygen saturation of 99% on ambient air. On exam, he was tremulous and had difficulty walking. His right upper extremity had patchy areas of burns, with the largest lesion measuring 12 x 5 cm (Image 1 and 2). There were ruptured blisters along his thumb and forearm and a non-ruptured blister on his index finger. The wound bed appeared pale pink, and the surrounding skin appeared intact with no signs of acute infection. He also had a small abrasion on the right side of his scalp. His complete blood count revealed a white blood cell count of 11.4 (4-10 x 10^9/L). His renal function, electrolytes, and liver enzymes were within normal range. He was noted to be intoxicated with alcohol and he had an elevated blood alcohol level of 41 mg/
IMAGE 3: Growth on a blood agar plate. Note the large, gray colonies surrounded by zones of β-hemolysis, which is characteristic of Group G streptococcus
20 J La State Med Soc VOL 169 JANUARY/FEBRUARY 2017 On day three of admission, he appeared acutely ill and a temperature of 101.2°F was recorded. Blood cultures were drawn and empiric antibiotic therapywas initiatedwith vancomycin and piperacillin-tazobactam. Blood cultures revealed the growth of beta- hemolytic Group G Streptococcus (Image 3). Antibiotics were narrowed to intravenous penicillin G and he was discharged home to complete a two week course of antibiotics. dl (<15 mg/dl). A non-contrast computed tomography (CT) of the head revealed diffuse cerebral and cerebellar atrophy. He was admitted for management of alcohol withdrawal and wound care.
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