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.