An unusual case of renal abscess caused by Streptococcus pneumoniae.

cefazolin sodium (1 g every 8 hours). His temperature decreased The most common manifestation of pneumococcal disease is except for an occasional elevation. On hospital day 2, an abdominal pneumonia, which has been associated with local complications CT showed an abscess affecting the lower pole of the right kidney (empyema, pericarditis, lung abscess), extrapulmonary infections (figure 1). A percutaneous drainage tube was placed into the ab(otitis media, sinusitis, meningitis), or less-common extrapulmoscess on hospital day 4. Cultures of the abscess and concomitant nary infections (endocarditis, septic arthritis, and peritonitis) [1]. blood cultures yielded oxacillin-susceptible S. pneumoniae. BeStreptococcus pneumoniae has also been associated with softcause of incomplete drainage, a second percutaneous tube was tissue infections (cellulitis, fasciitis, and abscess), especially in placed on hospital day 11. patients with connective tissue disease [2, 3]. Scott and Schmidt The patient became afebrile on hospital day 6. An echocardio[4] described psoas muscle abscess caused by S. pneumoniae. Pyogram did not reveal any clinically significant findings or any evigenic abscess of the gluteal muscle due to S. pneumoniae has dence of definite valvular vegetation. He was treated first with iv been also been reported [5]. Patients infected with HIV have an cefazolin for 12 days, and he then received oral cephalexin alone increased frequency of invasive pneumococcal disease, although for 4 weeks. He recovered fully without long-term complications. Janoff et al. [6] found that HIV-infected patients had symptoms When last seen 1 year after treatment, the patient was doing well. and signs that were similar to those in healthy hosts. This case was unusual because the primary disease process was A 50-year-old man with an unusual type of S. pneumoniae infecprobably a renal abscess (no other foci of infection were noted), tion was treated at our facility. He had a history of type II diabetes whereas extrapulmonary pneumococcal infection most often methat had been treated with oral medication. He complained of tastasizes from the lung. Moreover, the patient had no evidence of abdominal distention, nausea, vomiting, and fever that had begun respiratory disease or pneumonia and instead had fever, abdominal 6 weeks before admission to the hospital; night sweats and chills discomfort, and weight loss. also developed sometime before admission. At each of several A review of the English-language literature found only one case visits to the clinic, low-grade fever was noted, but the patient did in which S. pneumoniae was the pathogen in renal abscess [7]. not have any respiratory complaints. Organisms usually found in renal abscesses include StaphylococChest examination did not reveal any abnormalities, and findings cus aureus (in renal carbuncles); Escherichia coli, Klebsiella speon a chest roentgenogram were normal. The WBC count was cies, and Proteus mirabilis (in renal corticomedullary abscesses) 11,900 1 10/L, and the hemoglobin level and the hematocrit were