SHM Converge Scientific Abstract ePoster Gallery-Streptococcus Intermedius Bacteremia Progressing to End Stage Renal Disease

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A 78-year-old woman with coronary artery disease, hypertension, and asthma presented with fatigue, abdominal pain, diarrhea, and decreased urine output after recent travel to Southern France. She was found to have leukocytosis, elevated creatinine, abnormal liver enzymes, and imaging showing sigmoid wall thickening with liver abscesses. Her condition worsened to anuria, requiring emergent hemodialysis. Blood and liver abscess cultures grew Streptococcus intermedius, and the abscess was drained. Echocardiogram showed no endocarditis. Renal biopsy demonstrated acute interstitial nephritis (AIN).<br /><br />She was treated with IV ceftriaxone, metronidazole, and steroids, while an extensive infectious, hepatitis, and autoimmune workup remained negative. Despite clinical improvement and infection control, she had no renal recovery and remained dialysis-dependent, ultimately progressing to end-stage renal disease (ESRD). She was discharged on oral cefuroxime and metronidazole and continued outpatient follow-up with Infectious Disease and planned colonoscopy to evaluate for possible colon cancer, as S. intermedius bacteremia can be associated with gastrointestinal malignancy.<br /><br />The case highlights that Streptococcus intermedius, part of the normal oral and gastrointestinal flora, can cause invasive suppurative infections such as liver abscesses. Infections associated with AIN may be underrecognized and can lead to irreversible kidney damage. The report emphasizes the need for a high index of suspicion, prompt source control, and close renal monitoring, since renal failure may progress to ESRD despite treatment.

Asset Subtitle

Rabia Khan

Meta Tag

Author List George W. Garriss III, Rabia Khan, Usha Anand

Category Clinical Vignettes

Concept Streptococcus intermedius

Concept Acute Interstitial Nephritis

Concept Kidney Biopsy

Concept Infection-associated acute interstitial nephritis

Concept Streptococcus anginosus group

Distinguished Non-Finalist

Presenter Organization Wellstar Kennestone Hospital

Presenting Author Rabia Khan

Track Adult

Keywords

Streptococcus intermedius

acute interstitial nephritis

liver abscess

bacteremia

end-stage renal disease

hemodialysis

sigmoid wall thickening

colon cancer

ceftriaxone

renal biopsy

Streptococcus intermedius

Acute Interstitial Nephritis

Kidney Biopsy

Infection-associated acute interstitial nephritis

Streptococcus anginosus group