Background: Streptococcus sanguis comprises part of the normal flora of the human oral cavity. Although it has been recognized increasingly as an important pathogen of endocarditis, S. sanguis is a rare cause of urinary and iliopsoas abscess. Case Presentation: An 81-year-old male presented to the emergency department with complaints of pain in the right side of his back and gait disturbance. Laboratory results revealed slightly elevated inflammatory markers, moderately elevated renal function, and severe anemia. Computed tomography revealed right hydronephrosis and swollen iliopsoas. Ultrasonography revealed a distended right ureter that was affected by low echoic lesion in the iliopsoas. Iliopsoas abscess was suspected based on imaging results. In addition to administration of an antibacterial antibiotic, percutaneous drainage of the abscess was performed. Cultures of samples taken from the abscess and urine cultures were positive for S. sanguis. Fever and inflammatory reaction improved after drainage and antibiotic treatment. Three weeks after drainage, the patient had recovered uneventfully and returned home. Conclusion: It is important to recognize S. sanguis as a previously unrecognized species of Streptococcus in the etiology of iliopsoas abscess and to be aware of its predisposing factors. Sharing our experience with readers may help clinicians make the proper selection of antimicrobial agents, a key to the successful management of iliopsoas abscess.

Background: Pyrogenetic liver abscess is often caused by gram-negative bacilli, including Escheria coli or Klebsiella pneumoniae, but rarely by Streptococcus constellatus. Streptococcus constellatus is a commensal of the oral cavity, respiratory tract system, intestine, and urogenital organs. Herein, we report a case of multiple liver abscesses caused by Streptococcus constellatus. Case Presentation: A 66-year-old male presented with a high-grade fever with no known source. Laboratory analysis revealed severely elevated inflammation levels, moderately increased liver and biliary enzymes, and moderately worsened renal function. Sonazoid Ò (GE Healthcare AS, Oslo, Norway)-enhanced sonography revealed marginally contrast-enhanced masses with a non-contrastenhanced center. On the basis of these results, the patient was diagnosed with multiple liver abscesses. Subsequently, meropenem 1 g/d was prescribed. On day two, percutaneous abscess drainage was performed. Culture from abscess drainage and blood culture revealed the presence of Streptococcus constellatus. Because of antibiotic sensitivity, meropenem was replaced by piperacillin 6 g/d. Clinical course was uneventful and the patient was discharged on day 53. Conclusion: The pathogenic potential of Streptococcus constellatus has been recognized recently. Although the Streptococcus milleri group has been focused on primarily for its commensal nature, clinicians need to be aware of its pathogenic nature and biologic character of forming liver abscesses.

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