Multiple Lung Cavity Lesions, Thoracic Wall Abscess and Vertebral Destruction Caused by Streptococcus constellatus Infection: A Case Report

Abstract

Disseminated infection caused by Streptococcus constellatus was seldom occurred. We reported a case of Streptococcus constellatus infection, presenting as multiple pulmonary cavities, thoracic wall abscess and vertebral destruction. The 37-year-old male had recurrent fever, chest wall swelling and pain, and lower limb numbness, he had weak physical condition and previously suffered from poorly controlled diabetes and severe periodontal disease for 3 years. Definite diagnosis of Streptococcus constellatus infection was made by metagenomic next‑generation sequencing (mNGS) in abscess drainage fluid. Systemic antibiotics and thoracic wall drainage were given, and the pulmonary cavity and the thoracic intermuscular abscess were significantly decreased. Few to no study reported the disseminated infection (pulmonary cavities, thoracic wall abscess and vertebral destruction) caused by Streptococcus constellatus. This case report highlighted the importance of mNGS for accurate diagnosis, as well as the timely drainage and antibiotics for effective treatment of Streptococcus constellatus infection.

Keywords: Streptococcus constellatus; metagenomic next‑generation sequencing; pulmonary cavity; thoracic wall abscess; vertebral destruction.

Figure 1

PET/CT imaging on pulmonary cavity lesions and thoracic wall abscess. (A and B) CT imaging on multiple lung cavity lesions in the upper lobes. (C and D) PET scan revealed that the lung lesions, chest wall and thoracic vertebrae had higher levels of glucose metabolism (Green arrows).

Figure 2

Thoracic vertebrae MRI, (A) sagittal plane and (B) coronal plane, indicate hyperintense signals in T3-T4 vertebral bodies and paravertebral tissue (Yellow arrows).

Figure 3

Chest CT on pulmonary lesions and thoracic wall abscess before and after treatment. (A and D) Chest CT scan prior to admission. (B and E) Chest CT scan on discharge. (C and F) Chest CT scan at 3-month follow up. The red arrow indicated the change of the pulmonary cavities. The yellow arrow indicated the change of the thoracic wall abscess.