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Invasive Group G Streptococcal Infection Complicated by Posterior Reversible Encephalopathy Syndrome: A Case Report

Patient: Male, 89-year-old Final Diagnosis: Disseminated intravascular coagulation • duodenal ulcer • invasive group G streptococcal infection • posterior reversible encephalopathy syndrome Symptoms: Blood pressure drop • right shoulder pain • tarry stool Clinical Procedure: — Specialty: Infectious...

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Autores principales: Nakamura, Hironori, Adachi, Seiji, Uno, Yukari, Mabuchi, Masatoshi, Shimazaki, Makoto, Nishiwaki, Shinji, Shimizu, Masahito
Formato: Online Artículo Texto
Lenguaje:English
Publicado: International Scientific Literature, Inc. 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10697558/
https://www.ncbi.nlm.nih.gov/pubmed/38015823
http://dx.doi.org/10.12659/AJCR.942206
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author Nakamura, Hironori
Adachi, Seiji
Uno, Yukari
Mabuchi, Masatoshi
Shimazaki, Makoto
Nishiwaki, Shinji
Shimizu, Masahito
author_facet Nakamura, Hironori
Adachi, Seiji
Uno, Yukari
Mabuchi, Masatoshi
Shimazaki, Makoto
Nishiwaki, Shinji
Shimizu, Masahito
author_sort Nakamura, Hironori
collection PubMed
description Patient: Male, 89-year-old Final Diagnosis: Disseminated intravascular coagulation • duodenal ulcer • invasive group G streptococcal infection • posterior reversible encephalopathy syndrome Symptoms: Blood pressure drop • right shoulder pain • tarry stool Clinical Procedure: — Specialty: Infectious Diseases OBJECTIVE: Rare coexistence of disease or pathology BACKGROUND: Group G streptococcus (GGS) infection is reported to have invasive pathogenicity similar to that of group A streptococcus (GAS) infection, causing a strong systemic inflammatory response with bacteremia and various complications. Herein, we report a case of posterior reversible encephalopathy syndrome (PRES) as a rare complication of a GGS infection. CASE REPORT: An 89-year-old Japanese man presented to our hospital with gastrointestinal bleeding and shoulder pain. Close examination revealed a refractory duodenal ulcer (DU) with disseminated intravascular coagulation and soft tissue infection of the right arm, which was found to be caused by GGS. A hemorrhagic tendency due to disseminated intravascular coagulation made it difficult to achieve hemostasis, leading to repeated blood transfusions. Although remission of both the DU and infection was achieved with treatment, impairment of swallowing function and vision subsequently appeared. Magnetic resonance imaging revealed hyperintense lesions with elevated apparent diffusion coefficient (ADC) values on T2-weighted imaging (T2WI), fluid-attenuated inversion recovery (FLAIR), and diffusion-weighted imaging (DWI). The patient was diagnosed with PRES, which did not improve even after discharge on day 118. CONCLUSIONS: GGS infection developed with refractory duodenal ulcer bleeding, resulting in PRES with irreversible sequelae. The occurrence of PRES, which may be a rare complication of GGS infection, should be considered when central nervous system manifestations are observed in case of invasive streptococcal infection with a systemic inflammatory response.
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spelling pubmed-106975582023-12-06 Invasive Group G Streptococcal Infection Complicated by Posterior Reversible Encephalopathy Syndrome: A Case Report Nakamura, Hironori Adachi, Seiji Uno, Yukari Mabuchi, Masatoshi Shimazaki, Makoto Nishiwaki, Shinji Shimizu, Masahito Am J Case Rep Articles Patient: Male, 89-year-old Final Diagnosis: Disseminated intravascular coagulation • duodenal ulcer • invasive group G streptococcal infection • posterior reversible encephalopathy syndrome Symptoms: Blood pressure drop • right shoulder pain • tarry stool Clinical Procedure: — Specialty: Infectious Diseases OBJECTIVE: Rare coexistence of disease or pathology BACKGROUND: Group G streptococcus (GGS) infection is reported to have invasive pathogenicity similar to that of group A streptococcus (GAS) infection, causing a strong systemic inflammatory response with bacteremia and various complications. Herein, we report a case of posterior reversible encephalopathy syndrome (PRES) as a rare complication of a GGS infection. CASE REPORT: An 89-year-old Japanese man presented to our hospital with gastrointestinal bleeding and shoulder pain. Close examination revealed a refractory duodenal ulcer (DU) with disseminated intravascular coagulation and soft tissue infection of the right arm, which was found to be caused by GGS. A hemorrhagic tendency due to disseminated intravascular coagulation made it difficult to achieve hemostasis, leading to repeated blood transfusions. Although remission of both the DU and infection was achieved with treatment, impairment of swallowing function and vision subsequently appeared. Magnetic resonance imaging revealed hyperintense lesions with elevated apparent diffusion coefficient (ADC) values on T2-weighted imaging (T2WI), fluid-attenuated inversion recovery (FLAIR), and diffusion-weighted imaging (DWI). The patient was diagnosed with PRES, which did not improve even after discharge on day 118. CONCLUSIONS: GGS infection developed with refractory duodenal ulcer bleeding, resulting in PRES with irreversible sequelae. The occurrence of PRES, which may be a rare complication of GGS infection, should be considered when central nervous system manifestations are observed in case of invasive streptococcal infection with a systemic inflammatory response. International Scientific Literature, Inc. 2023-11-28 /pmc/articles/PMC10697558/ /pubmed/38015823 http://dx.doi.org/10.12659/AJCR.942206 Text en © Am J Case Rep, 2023 https://creativecommons.org/licenses/by-nc-nd/4.0/This work is licensed under Creative Common Attribution-NonCommercial-NoDerivatives 4.0 International (CC BY-NC-ND 4.0 (https://creativecommons.org/licenses/by-nc-nd/4.0/) )
spellingShingle Articles
Nakamura, Hironori
Adachi, Seiji
Uno, Yukari
Mabuchi, Masatoshi
Shimazaki, Makoto
Nishiwaki, Shinji
Shimizu, Masahito
Invasive Group G Streptococcal Infection Complicated by Posterior Reversible Encephalopathy Syndrome: A Case Report
title Invasive Group G Streptococcal Infection Complicated by Posterior Reversible Encephalopathy Syndrome: A Case Report
title_full Invasive Group G Streptococcal Infection Complicated by Posterior Reversible Encephalopathy Syndrome: A Case Report
title_fullStr Invasive Group G Streptococcal Infection Complicated by Posterior Reversible Encephalopathy Syndrome: A Case Report
title_full_unstemmed Invasive Group G Streptococcal Infection Complicated by Posterior Reversible Encephalopathy Syndrome: A Case Report
title_short Invasive Group G Streptococcal Infection Complicated by Posterior Reversible Encephalopathy Syndrome: A Case Report
title_sort invasive group g streptococcal infection complicated by posterior reversible encephalopathy syndrome: a case report
topic Articles
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10697558/
https://www.ncbi.nlm.nih.gov/pubmed/38015823
http://dx.doi.org/10.12659/AJCR.942206
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