A49-43 Unusual Suspects: Streptococcus Pneumoniae Bacteremia From a Tubo-ovarian Abscess
Abstract
Streptococcus pneumoniae is a pathogen frequently implicated in pneumonia, sinusitis, and otitis media.1 Invasive pneumococcal infections typically occur when a pulmonary infection spreads to the bloodstream.1 We describe a unique case of a primary tubo-ovarian abscess (TOA) caused by S. pneumoniae, which progressed to secondary bacterial peritonitis and bacteremia. While invasive S. pneumoniae infections starting in the lungs are common, primary intra-abdominal infections with secondary bacteremia are rare.2-5 This case illustrates this rare occurrence of a primary intra-abdominal infection as the source of invasive disease.
A 54-year-old female with heart failure, diabetes mellitus, and hypertension presented with two days of abdominal pain, nausea, vomiting, and diarrhea. She denied respiratory symptoms. On admission, she was found to be in shock, and the physical exam was notable for abdominal tenderness and ascites. GI PCR was positive for Clostridioides difficile, which was treated with oral vancomycin. Blood cultures were positive for gram positive cocci on hospital day (HD) 1 with multiplex PCR identifying Streptococcus pneumoniae. CT imaging of the abdomen and pelvis demonstrated colitis and left adnexal multiloculated cystic lesions (Image 1) initially concerning for a malignancy. Chest imaging did not show signs of pneumonia. Frank pus was visualized on diagnostic paracentesis on HD1 with the gram stain demonstrating only gram-positive cocci. She underwent…
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