Invasive Group B streptococcus: multiloculated perinephric abscesses treated with percutaneous drainage

Group B streptococcus infections (GBSI) are commonly associated with neonates and pregnant women, but may also affect nonpregnant adults. Among its spectrum of manifestations, perinephric abscess (PA) is exceedingly rare. Comorbid conditions such as diabetes mellitus (DM) and immunosuppression increase the risk of GBSI. We describe a 61-year-old Vietnamese man with compensated alcoholic cirrhosis, who presented with acute encephalopathy following subacute, progressive abdominal pain. He was afebrile and hemodynamically stable. Laboratory data were remarkable for leukocytosis, thrombocytopenia, azotemia, and pyuria. He was found to have two right-sided PA measuring 15 × 10 × 11 cm and 4.6 × 2.7 × 7.8 cm, requiring interval placement of multiple percutaneous drains. Culture from abscesses revealed beta-hemolytic Group B streptococcus (GBS). His course was complicated by contiguous spread to abdominal wall and paraspinal musculature, as well as a new diagnosis of type 2 DM. Along with drainage, a prolonged course of intravenous antimicrobial treatment led to abscess resolution. Given the rising number of unusual clinical presentations of GBSI, this bacteria should be considered as a part of the microbiological differential diagnosis of PA, especially in conditions leading to immunosuppression.