Hemorrhagic pneumonia and upper lobe pulmonary cavitary lesion caused by Streptococcus pyogenes

Abstract

A 33-year-old previously healthy man from Mexico who presented with massive hemoptysis, fevers, chills and found to have cavitary lesions in the right upper lobe of lung was highly suspicious for tuberculosis. The patient was treated with vancomycin, ceftriaxone, azithromycin and placed on isolation for suspected tuberculosis. Sputum AFB stains were negative and blood cultures grew Group A Streptococcus [GAS]. Antibiotics were narrowed down to ampicillin-sulbactam and the patient was discharged with significant clinical improvement. Strep A pyogenes is a rare cause of cavitary hemorrhagic pneumonia but is associated with high mortality. Clinical suspicion and early diagnosis are crucial in saving the patient.

Group A Streptococcus Pneumonia in a Previously Healthy Individual: Is It Still a Thing?

“…Additional sources indicate that Group A strep. infections are responsible for less than 1% of community-acquired cases and are usually associated with invasive species such as strains M1 and M3 [ 3 - 5 ]. However, when it manifests as pneumonia, the morbidity caused by this pathogen can vary greatly.…”

“…Cases of GAS pneumonia are still observed in high-density population areas such as in the military or prisons. Another condition where infections have been observed is in patients with a previous viral infection, such as influenza, who become vulnerable to a secondary infection with GAS [ 1 , 3 ]. It is less common to observe this infection in previously healthy individuals without exposure to sick contacts.…”