Academic Journal
Retroperitoneal infection associated with Streptococcus dysgalactiae subsp. equisimilis bacteremia and lower-extremity cellulitis: a case report.
| Title: | Retroperitoneal infection associated with Streptococcus dysgalactiae subsp. equisimilis bacteremia and lower-extremity cellulitis: a case report. |
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| Authors: | Fujisawa T; Department of Emergency and Critical Care Medicine, National Hospital Organization Tokyo Medical Center, Tokyo, Japan. Electronic address: tokuo.fujisawa@icloud.com. |
| Source: | Journal of infection and chemotherapy : official journal of the Japan Society of Chemotherapy [J Infect Chemother] 2026 Oct; Vol. 32 (10), pp. 103039. Date of Electronic Publication: 2026 Jul 22. |
| Publication Type: | Case Reports; Journal Article |
| Language: | English |
| Journal Info: | Publisher: Elsevier Country of Publication: Netherlands NLM ID: 9608375 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1437-7780 (Electronic) Linking ISSN: 1341321X NLM ISO Abbreviation: J Infect Chemother Subsets: MEDLINE |
| Imprint Name(s): | Publication: 2014- : Amsterdam : Elsevier Original Publication: Tokyo : New York : Published for the Society by Churchill Livingstone, c1995- |
| MeSH Terms: | Cellulitis*/microbiology , Cellulitis*/drug therapy , Cellulitis*/complications , Streptococcus*/isolation & purification , Streptococcal Infections*/microbiology , Streptococcal Infections*/drug therapy , Streptococcal Infections*/diagnosis , Streptococcal Infections*/complications , Bacteremia*/microbiology , Bacteremia*/drug therapy, Retroperitoneal Space/microbiology ; Retroperitoneal Space/diagnostic imaging ; Anti-Bacterial Agents/therapeutic use ; Lower Extremity/microbiology ; Lymphangitis/microbiology ; Humans ; Male ; Aged ; Tomography, X-Ray Computed |
| Abstract: | Streptococcus dysgalactiae subsp. equisimilis (SDSE) is an increasingly recognized β-hemolytic streptococcus causing invasive infections resembling those caused by Streptococcus pyogenes. Although SDSE bacteremia commonly arises from skin and soft tissue infections, retroperitoneal infection has rarely been described. We report SDSE bacteremia with retroperitoneal lymphatic involvement suggesting possible extension from lower-extremity cellulitis. A 70-year-old man with diabetes and alcoholic liver disease presented with fever and difficulty moving and was admitted with septic shock. Initial computed tomography showed retroperitoneal lymphadenopathy, retroperitoneal inflammatory changes, and right inguinal lymphadenopathy, without gastrointestinal perforation, pancreatitis, obstructive uropathy, or abscess. On hospital day 2, right lower-leg cellulitis became evident. Blood cultures grew SDSE expressing Lancefield group A antigen. Follow-up computed tomography on hospital day 7 showed persistent retroperitoneal inflammatory changes, dilated retroperitoneal lymphatic vessels, and a thrombus near the left venous angle. These findings were compatible with retroperitoneal lymphadenitis and lymphangitis with secondary inflammation of the surrounding retroperitoneal tissue. No persistent bacteremia, infective endocarditis, osteoarticular infection, abscess formation, or other uncontrolled metastatic focus was identified. Antimicrobial therapy was discontinued on hospital day 15 after bacteremia clearance and clinical improvement. Anticoagulation was administered for the thrombus near the left venous angle and a subsequently detected pulmonary embolism. At 3 months, the retroperitoneal lesions and thrombi had resolved, and no relapse occurred during 6 months of follow-up. This case suggests that SDSE cellulitis may rarely be associated with retroperitoneal lymphatic involvement. In the absence of abscess formation or persistent metastatic infection, prolonged antimicrobial therapy may not necessarily be required. (Copyright © 2026 Japanese Society of Chemotherapy, Japanese Association for Infectious Diseases, and Japanese Society for Infection Prevention and Control. Published by Elsevier Ltd. All rights reserved.) |
| Competing Interests: | Declaration of competing interests The author declares that there are no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper. |
| Contributed Indexing: | Keywords: Cellulitis; Lymphadenitis; Lymphatic dissemination; Retroperitoneal infection; SDSE; Streptococcus dysgalactiae subsp. equisimilis |
| Substance Nomenclature: | 0 (Anti-Bacterial Agents) |
| SCR Organism: | Streptococcus dysgalactiae subsp. equisimilis |
| Entry Date(s): | Date Created: 20260722 Date Completed: 20260904 Latest Revision: 20260904 |
| Update Code: | 20260905 |
| DOI: | 10.1016/j.jiac.2026.103039 |
| PMID: | 42486338 |
| Database: | MEDLINE |
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| Items | – Name: Title Label: Title Group: Ti Data: Retroperitoneal infection associated with Streptococcus dysgalactiae subsp. equisimilis bacteremia and lower-extremity cellulitis: a case report. – Name: Author Label: Authors Group: Au Data: <searchLink fieldCode="AU" term="%22Fujisawa+T%22">Fujisawa T</searchLink>; Department of Emergency and Critical Care Medicine, National Hospital Organization Tokyo Medical Center, Tokyo, Japan. Electronic address: tokuo.fujisawa@icloud.com. – Name: TitleSource Label: Source Group: Src Data: <searchLink fieldCode="JN" term="%229608375%22">Journal of infection and chemotherapy : official journal of the Japan Society of Chemotherapy</searchLink> [J Infect Chemother] 2026 Oct; Vol. 32 (10), pp. 103039. <i>Date of Electronic Publication: </i>2026 Jul 22. – Name: TypePub Label: Publication Type Group: TypPub Data: Case Reports; Journal Article – Name: Language Label: Language Group: Lang Data: English – Name: TitleSource Label: Journal Info Group: Src Data: <i>Publisher: </i><searchLink fieldCode="PB" term="%22Elsevier%22">Elsevier </searchLink><i>Country of Publication: </i>Netherlands <i>NLM ID: </i>9608375 <i>Publication Model: </i>Print-Electronic <i>Cited Medium: </i>Internet <i>ISSN: </i>1437-7780 (Electronic) <i>Linking ISSN: </i><searchLink fieldCode="IS" term="%221341321X%22">1341321X </searchLink><i>NLM ISO Abbreviation: </i>J Infect Chemother <i>Subsets: </i>MEDLINE – Name: PublisherInfo Label: Imprint Name(s) Group: PubInfo Data: <i>Publication</i>: 2014- : Amsterdam : Elsevier<br /><i>Original Publication</i>: Tokyo : New York : Published for the Society by Churchill Livingstone, c1995- – Name: SubjectMESH Label: MeSH Terms Group: Su Data: <searchLink fieldCode="MM" term="%22Cellulitis%22">Cellulitis*</searchLink>/<searchLink fieldCode="MM" term="%22Cellulitis+microbiology%22">microbiology</searchLink> <br /><searchLink fieldCode="MM" term="%22Cellulitis%22">Cellulitis*</searchLink>/<searchLink fieldCode="MM" term="%22Cellulitis+drug+therapy%22">drug therapy</searchLink> <br /><searchLink fieldCode="MM" term="%22Cellulitis%22">Cellulitis*</searchLink>/<searchLink fieldCode="MM" term="%22Cellulitis+complications%22">complications</searchLink> <br /><searchLink fieldCode="MM" term="%22Streptococcus%22">Streptococcus*</searchLink>/<searchLink fieldCode="MM" term="%22Streptococcus+isolation+%26+purification%22">isolation & purification</searchLink> <br /><searchLink fieldCode="MM" term="%22Streptococcal+Infections%22">Streptococcal Infections*</searchLink>/<searchLink fieldCode="MM" term="%22Streptococcal+Infections+microbiology%22">microbiology</searchLink> <br /><searchLink fieldCode="MM" term="%22Streptococcal+Infections%22">Streptococcal Infections*</searchLink>/<searchLink fieldCode="MM" term="%22Streptococcal+Infections+drug+therapy%22">drug therapy</searchLink> <br /><searchLink fieldCode="MM" term="%22Streptococcal+Infections%22">Streptococcal Infections*</searchLink>/<searchLink fieldCode="MM" term="%22Streptococcal+Infections+diagnosis%22">diagnosis</searchLink> <br /><searchLink fieldCode="MM" term="%22Streptococcal+Infections%22">Streptococcal Infections*</searchLink>/<searchLink fieldCode="MM" term="%22Streptococcal+Infections+complications%22">complications</searchLink> <br /><searchLink fieldCode="MM" term="%22Bacteremia%22">Bacteremia*</searchLink>/<searchLink fieldCode="MM" term="%22Bacteremia+microbiology%22">microbiology</searchLink> <br /><searchLink fieldCode="MM" term="%22Bacteremia%22">Bacteremia*</searchLink>/<searchLink fieldCode="MM" term="%22Bacteremia+drug+therapy%22">drug therapy</searchLink><br /><searchLink fieldCode="MH" term="%22Retroperitoneal+Space%22">Retroperitoneal Space</searchLink>/<searchLink fieldCode="MH" term="%22Retroperitoneal+Space+microbiology%22">microbiology</searchLink> ; <searchLink fieldCode="MH" term="%22Retroperitoneal+Space%22">Retroperitoneal Space</searchLink>/<searchLink fieldCode="MH" term="%22Retroperitoneal+Space+diagnostic+imaging%22">diagnostic imaging</searchLink> ; <searchLink fieldCode="MH" term="%22Anti-Bacterial+Agents%22">Anti-Bacterial Agents</searchLink>/<searchLink fieldCode="MH" term="%22Anti-Bacterial+Agents+therapeutic+use%22">therapeutic use</searchLink> ; <searchLink fieldCode="MH" term="%22Lower+Extremity%22">Lower Extremity</searchLink>/<searchLink fieldCode="MH" term="%22Lower+Extremity+microbiology%22">microbiology</searchLink> ; <searchLink fieldCode="MH" term="%22Lymphangitis%22">Lymphangitis</searchLink>/<searchLink fieldCode="MH" term="%22Lymphangitis+microbiology%22">microbiology</searchLink> ; <searchLink fieldCode="MH" term="%22Humans%22">Humans</searchLink> ; <searchLink fieldCode="MH" term="%22Male%22">Male</searchLink> ; <searchLink fieldCode="MH" term="%22Aged%22">Aged</searchLink> ; <searchLink fieldCode="MH" term="%22Tomography%2C+X-Ray+Computed%22">Tomography, X-Ray Computed</searchLink> – Name: Abstract Label: Abstract Group: Ab Data: Streptococcus dysgalactiae subsp. equisimilis (SDSE) is an increasingly recognized β-hemolytic streptococcus causing invasive infections resembling those caused by Streptococcus pyogenes. Although SDSE bacteremia commonly arises from skin and soft tissue infections, retroperitoneal infection has rarely been described. We report SDSE bacteremia with retroperitoneal lymphatic involvement suggesting possible extension from lower-extremity cellulitis. A 70-year-old man with diabetes and alcoholic liver disease presented with fever and difficulty moving and was admitted with septic shock. Initial computed tomography showed retroperitoneal lymphadenopathy, retroperitoneal inflammatory changes, and right inguinal lymphadenopathy, without gastrointestinal perforation, pancreatitis, obstructive uropathy, or abscess. On hospital day 2, right lower-leg cellulitis became evident. Blood cultures grew SDSE expressing Lancefield group A antigen. Follow-up computed tomography on hospital day 7 showed persistent retroperitoneal inflammatory changes, dilated retroperitoneal lymphatic vessels, and a thrombus near the left venous angle. These findings were compatible with retroperitoneal lymphadenitis and lymphangitis with secondary inflammation of the surrounding retroperitoneal tissue. No persistent bacteremia, infective endocarditis, osteoarticular infection, abscess formation, or other uncontrolled metastatic focus was identified. Antimicrobial therapy was discontinued on hospital day 15 after bacteremia clearance and clinical improvement. Anticoagulation was administered for the thrombus near the left venous angle and a subsequently detected pulmonary embolism. At 3 months, the retroperitoneal lesions and thrombi had resolved, and no relapse occurred during 6 months of follow-up. This case suggests that SDSE cellulitis may rarely be associated with retroperitoneal lymphatic involvement. In the absence of abscess formation or persistent metastatic infection, prolonged antimicrobial therapy may not necessarily be required.<br /> (Copyright © 2026 Japanese Society of Chemotherapy, Japanese Association for Infectious Diseases, and Japanese Society for Infection Prevention and Control. Published by Elsevier Ltd. All rights reserved.) – Name: Abstract Label: Competing Interests Group: Ab Data: Declaration of competing interests The author declares that there are no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper. – Name: SubjectMinor Label: Contributed Indexing Group: Data: <i>Keywords: </i>Cellulitis; Lymphadenitis; Lymphatic dissemination; Retroperitoneal infection; SDSE; Streptococcus dysgalactiae subsp. equisimilis – Name: NumberCAS Label: Substance Nomenclature Group: ID Data: 0 (Anti-Bacterial Agents) – Name: SubjectOther Label: SCR Organism Group: Su Data: Streptococcus dysgalactiae subsp. equisimilis – Name: DateEntry Label: Entry Date(s) Group: Date Data: <i>Date Created: </i>20260722 <i>Date Completed: </i>20260904 <i>Latest Revision: </i>20260904 – Name: DateUpdate Label: Update Code Group: Date Data: 20260905 – Name: DOI Label: DOI Group: ID Data: 10.1016/j.jiac.2026.103039 – Name: AN Label: PMID Group: ID Data: 42486338 |
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| RecordInfo | BibRecord: BibEntity: Identifiers: – Type: doi Value: 10.1016/j.jiac.2026.103039 Languages: – Code: eng Text: English PhysicalDescription: Pagination: StartPage: 103039 Subjects: – SubjectFull: Retroperitoneal Space microbiology Type: general – SubjectFull: Retroperitoneal Space diagnostic imaging Type: general – SubjectFull: Anti-Bacterial Agents therapeutic use Type: general – SubjectFull: Lower Extremity microbiology Type: general – SubjectFull: Lymphangitis microbiology Type: general – SubjectFull: Humans Type: general – SubjectFull: Male Type: general – SubjectFull: Aged Type: general – SubjectFull: Tomography, X-Ray Computed Type: general – SubjectFull: Cellulitis microbiology Type: general – SubjectFull: Cellulitis drug therapy Type: general – SubjectFull: Cellulitis complications Type: general – SubjectFull: Streptococcus isolation & purification Type: general – SubjectFull: Streptococcal Infections microbiology Type: general – SubjectFull: Streptococcal Infections drug therapy Type: general – SubjectFull: Streptococcal Infections diagnosis Type: general – SubjectFull: Streptococcal Infections complications Type: general – SubjectFull: Bacteremia microbiology Type: general – SubjectFull: Bacteremia drug therapy Type: general Titles: – TitleFull: Retroperitoneal infection associated with Streptococcus dysgalactiae subsp. equisimilis bacteremia and lower-extremity cellulitis: a case report. Type: main BibRelationships: HasContributorRelationships: – PersonEntity: Name: NameFull: Fujisawa T IsPartOfRelationships: – BibEntity: Dates: – D: 01 M: 10 Text: 2026 Oct Type: published Y: 2026 Identifiers: – Type: issn-electronic Value: 1437-7780 Numbering: – Type: volume Value: 32 – Type: issue Value: 10 Titles: – TitleFull: Journal of infection and chemotherapy : official journal of the Japan Society of Chemotherapy Type: main |
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