PDF(Pubmed)
Abstract：
Streptococcus pyogenes (S. pyogenes) is a gram-positive, facultative anaerobic bacterium that appears as cocci in chains and commonly causes skin infections and pharyngitis. Here, we present a very uncommon case of cholangitis associated with invasive S. pyogenes infection in a 34-year-old man with metastatic pancreatic adenocarcinoma who presented with fever, right upper quadrant pain, jaundice, altered mental status, and hypotension. The patient underwent a percutaneous transhepatic cholangiogram, showing moderate dilatation of intrahepatic biliary ducts with obstruction of the proximal common bile duct, and an internal/external biliary drain was placed to allow for the flow of bile. Blood cultures grew S. pyogenes. Biliary fluid culture obtained at the time of drain placement grew S. pyogenes, lactobacilli, and saccharomyces. The patient was treated with ampicillin-sulbactam and fluconazole. While the patient recovered from his sepsis, he died within weeks of diagnosis due to complications of metastatic disease.
摘要：
化脓性链球菌（S.化脓性）是革兰氏阳性，兼性厌氧细菌，以球菌的形式出现，通常会引起皮肤感染和咽炎。这里,我们介绍了一例罕见的与侵袭性化脓性链球菌感染相关的胆管炎病例，患者34岁，患有转移性胰腺腺癌，并伴有发热。右上腹疼痛,黄疸,精神状态改变,和低血压。患者接受了经皮肝穿刺胆管造影,显示肝内胆管中度扩张伴近端胆总管阻塞，并放置内部/外部胆道引流以允许胆汁流动。血液培养物生长为化脓性链球菌。引流时获得的胆汁液培养物生长了化脓性链球菌，乳酸杆菌,和酵母。患者接受氨苄西林-舒巴坦和氟康唑治疗。当病人从他的败血症中恢复时,由于转移性疾病的并发症，他在诊断后几周内死亡。
