DISCUSSION
As described previously, cutaneous manifestations of Group Cstreptococcus (GCS) are fairly uncommon in the clinical setting,
however not unheard of. GCS bacteremia that are associated with
cutaneous eruptions have been described in past
literature.5,8 GCS in and of itself as an isolated
finding on blood culture, is fairly rare and generally encountered in
individuals with comorbidities such as immunosuppression or malignancy.
In the context of an otherwise healthy female patient, the incidence of
cutaneous lesions of Group C bacteremia are exceedingly rare.Strep dysgalactiae is a member of the group C Strep family. It is
a gram-positive coccus that is in a chain configuration and beta
hemolytic.3 Strep dysgalactiae is a
commensal bacteria that is found mostly in the alimentary tract or
genital tract, but can occasionally be found on skin as a component of
the skin flora. Initially, this group of strep was thought to be
non-pathogenic in humans, however, recent findings have shown that some
skin and tonsillar infections are a result of Strep dysgalactiaecolonization.3 It is postulated that strep
dysgalactiae can be responsible for some cellulitis
cases.4,7 Aside from local cellulitis or erysipelas,
other cutaneous manifestations can be seen in the context of a systemic
bacteremia.4 In literature, rare cases of Strep
dysgalactiae bacteremia can present with a diffuse papular rash that
can expand to the trunk and extremities. Cases of necrotizing fasciitis
are also attributed to Strep dysgalactiae . This case report
presents a patient with Strep dysgalactiae bacteremia associated
with tender macular exanthem on bilaterally upper and lower extremities
and trunk, myalgias and weakness. This is a fairly rare presentation of
GCS bacteremia than what is often seen clinically. Generally, Group C
strep bacteremia presents as a profound sepsis or meningitis with
resultant positive blood cultures. 6 In this
case, the patient had no findings significant for meningitis. The
patient presented with significant systemic findings of fever, myalgia,
arthralgia, elevated LFTs, sepsis and thrombocytopenia with diffusely
tender exanthem. There are very few case presentations on Group C strep
bacteremia with diffuse myalgias and associated cutaneous
manifestations. The resolution of the rash and pain with antibiotics
therapy and negative re-growth of Strep dysgalactiae on blood
culture indicated an infectious process, thus supporting our rare case
presentation. In addition to the atypical presentation of Group C strep
which is very sparsely described in literature, our patient’s
dermatological findings were also distinct from the prior accounts ofStrep dysgalactiae associated cutaneous lesions. This case
corroborates the current emphasis toward Strep dysgalactiae as a
pathogen of increasing suspicion when faced with variable clinical
presentations.