A classic and fatal case of Streptococcus mutans subacute bacterial endocarditis; A now potentially underappreciated disease

Acute bacterial endocarditis is now common and easily suspected and recognized in the setting of prosthetic valves, injection drug use, or bacteremia with virulent organisms. Conversely, subacute bacterial endocarditis has drastically decreased in incidence, and recognition may be further hampered by the indolent non-specific presentation. Delayed diagnosis is common and can lead to serious complications and fatalities. We describe a patient found to have Streptococcus mutans subacute bacterial endocarditis, who presented with classic risk factors and findings, and who died shortly after presentation due to hemorrhagic conversion of an embolic stroke in the setting of anticoagulation. It is critical that all cases of streptococcal bacteremia be appropriately evaluated and treated, and that Streptococcus spp. not ever be routinely considered a blood culture ‘contaminant’. Keywords: Subacute bacterial endocarditis, Streptococcus mutans, viridans group streptococci, Leukocytoclastic vasculitis, Infective endocarditi

Spontaneous Streptococcus pyogenes pelvic inflammatory disease; Case report and review of the literature

Streptococcus pyogenes gynecological infections generally occur in association with childbirth, intra-uterine devices, and other invasive gynecologic procedures, but rarely cause spontaneous pelvic inflammatory disease. We describe a case of a healthy young woman with spontaneous S. pyogenes pelvic inflammatory disease, bacteremia, and shock, and summarize an additional 13 cases found in the literature. The majority were bacteremic and a significant number were also hypotensive. The same proportion had presenting gastrointestinal symptoms as had genitourinary symptoms, masking the diagnosis in many. Many prior case reports postulate a connection with S. pyogenes pharyngitis in a close contact, and an oro-genital route of transmission has been proposed given the exceedingly low rates of genital colonization with S. pyogenes. A high index of suspicion is needed for an accurate and timely diagnosis of this rare but potentially fatal condition