DIFFERENTIAL DIAGNOSIS AND TREATMENT
Group C streptococcus bacteremia with cutaneous manifestations can be misdiagnosed with necrotizing fasciitis, toxic shock syndrome, contact dermatitis, and drug eruption. Computerized tomography scan of the upper and lower extremities revealed no subcutaneous air tracking in fascial planes which would normally be seen in necrotizing fasciitis. Clinical exam finding of no crepitation with palpation on the right upper extremity was also a negative finding for necrotizing fasciitis. Toxic shock syndrome (TSS) was also ruled out due to lack of hemodynamic instability and other associated systemic findings. Negative blood cultures for the most common pathogen of TSS and lack of risk factors supported the decision. Contact dermatitis was able to be excluded via history taking in which the patient denied any changes in soaps, detergents, clothing, and denial of any other potential toxic contact. Finally, thorough reconciliation of medication list as well as denial of any medical changes ruled out any drug associated eruption. The diagnosis was confirmed with blood cultures done twice which were positive for GCS species.
Treatment of GCS bacteremia is similar to other streptococci infections. Generally, Group C strep is sensitive to Beta-lactam antibiotics such as penicillin or cephalosporins.4 Treatment of severe bacteremia can be accomplished with large dose penicillin G (3,000,000 units) every four hours or third generation cephalosporins.4 Treatment duration should last till about three or four days after the resolution of fever or clinical signs of infection. For individuals with significant allergies to beta-lactam antibiotics, linezolid or vancomycin can be effective.4 While treating for infection, supportive care for symptoms should also be provided. Hydration should be maintained with IV normal saline infusion. Pain and fever should be managed with appropriate analgesics and antipyretics. Upon discharge, this patient was advised to complete the antibiotic course of oral ceftin.