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Group A Streptococcal Pneumonia: A Case Report
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A5228 - Group A Streptococcal Pneumonia: A Case Report
Author Block: A. Amin, S. Kwatra, S. Sheth; Internal Medicine, Western Reserve Health Education, Youngstown, OH, United States.
Introduction:
Group A Streptococcus Pneumonia is a rare cause of community associated pneumonia associated with increased incidence of multi-organ failure and mortality. Here we examine one such case of community acquired GAS pneumonia.
Case Presentation:
36-year-old female with PMH of hypertension presented with complaint of right-sided chest pain. She contributes that she had been sick for past 5 days with fever, chills, cough, and congestion. However, she began to feel sharp pain on right upper chest wall radiating to her back and worse on inspiration. She denied any sick contacts or recent travels. CT Chest showed large area of consolidation involving the right upper and lower lobes with a small right side pleural effusion. Patient was started on azithromycin and ceftriaxone for CAP. She also had acute renal failure with a Cr 3.09 (baseline Cr 1.0) and Nephrology was consulted. Unfortunately, her condition clinically worsened as she became more dyspneic and her oxygen requirement increased to 15 L via HFNC. She also spiked a fever T 103 and WBC count trended up from 8 to 14.4. Blood cultures came back positive for Group A Streptococcus. Patient was thereafter transfer to the MICU and started on IV Penicillin G. She continued course of Penicillin G and gradually her clinical condition improved over a 2 week course. Her WBC and Cr normalized and she was eventually weaned of supplemental O2. She was discharged home with instructions for close follow up.
Discussion:
Despite the fact that Group A streptococcal infections notorious for being major causes of mortality and morbidity, the occurrence of group A streptococcal pneumonia is rare. The disease can be fast occurring and devastating if not treated immediately with the appropriate antibiotic therapy and supportive measures. One study showed that GAS pneumonia was associated with more effusions and morbidity and compared to pneumonia associated with Strep pneumonia. Complications associated with this condition include multiorgan failure and toxic shock syndrome. It is no unusual for patients to describe a biphasic illness. They may have flu-like symptoms, which improved before coming in with worsening symptoms associated with GAS pneumonia.
Conclusion:
In summary, although GAS pneumonia is a rare cause of community acquired pneumonia there should be a high suspicion of this disease especially in patients who contribute a history of recent viral illness. Delays in diagnosis can often prove to be associated with multi-organ failure and fatality if not treated immediately.
Author Block: A. Amin, S. Kwatra, S. Sheth; Internal Medicine, Western Reserve Health Education, Youngstown, OH, United States.
Introduction:
Group A Streptococcus Pneumonia is a rare cause of community associated pneumonia associated with increased incidence of multi-organ failure and mortality. Here we examine one such case of community acquired GAS pneumonia.
Case Presentation:
36-year-old female with PMH of hypertension presented with complaint of right-sided chest pain. She contributes that she had been sick for past 5 days with fever, chills, cough, and congestion. However, she began to feel sharp pain on right upper chest wall radiating to her back and worse on inspiration. She denied any sick contacts or recent travels. CT Chest showed large area of consolidation involving the right upper and lower lobes with a small right side pleural effusion. Patient was started on azithromycin and ceftriaxone for CAP. She also had acute renal failure with a Cr 3.09 (baseline Cr 1.0) and Nephrology was consulted. Unfortunately, her condition clinically worsened as she became more dyspneic and her oxygen requirement increased to 15 L via HFNC. She also spiked a fever T 103 and WBC count trended up from 8 to 14.4. Blood cultures came back positive for Group A Streptococcus. Patient was thereafter transfer to the MICU and started on IV Penicillin G. She continued course of Penicillin G and gradually her clinical condition improved over a 2 week course. Her WBC and Cr normalized and she was eventually weaned of supplemental O2. She was discharged home with instructions for close follow up.
Discussion:
Despite the fact that Group A streptococcal infections notorious for being major causes of mortality and morbidity, the occurrence of group A streptococcal pneumonia is rare. The disease can be fast occurring and devastating if not treated immediately with the appropriate antibiotic therapy and supportive measures. One study showed that GAS pneumonia was associated with more effusions and morbidity and compared to pneumonia associated with Strep pneumonia. Complications associated with this condition include multiorgan failure and toxic shock syndrome. It is no unusual for patients to describe a biphasic illness. They may have flu-like symptoms, which improved before coming in with worsening symptoms associated with GAS pneumonia.
Conclusion:
In summary, although GAS pneumonia is a rare cause of community acquired pneumonia there should be a high suspicion of this disease especially in patients who contribute a history of recent viral illness. Delays in diagnosis can often prove to be associated with multi-organ failure and fatality if not treated immediately.
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