Streptococcus anginosus Bacteremia with Hepatic Abscess After Biliary Stent Exchange in a Patient with Relapsed Lymphoma: A Case Report : Case Report

Kyaw Zaw Lin; Soraya Kernizan

doi:10.58372/2835-6276.1382

Authors

Kyaw Zaw Lin
Soraya Kernizan

DOI:

https://doi.org/10.58372/2835-6276.1382

Keywords:

Streptococcus anginosus, Hepatic Abscess, Bacteremia

Abstract

A 46-year-old woman with a history of relapsed and transformed lymphoma, including marginal zone lymphoma (MZL), Hodgkin lymphoma, and subsequent transformation to diffuse large B-cell lymphoma (DLBCL) with hepatic involvement, presented with Streptococcus anginosus bacteremia and suspected hepatic abscesses following recent biliary instrumentation. She had previously undergone multiple lines of therapy, most recently chimeric antigen receptor T-cell (CAR-T) therapy with axicabtagene ciloleucel in July 2025, achieving an initial complete metabolic response.

Her clinical course was complicated by chronic obstructive cholestasis requiring biliary stent placement and serial endoscopic retrograde cholangiopancreatography (ERCP) procedures. Following a recent ERCP with stent exchange and lymph node biopsy in March 2026, she presented with fever and chills and was found to have S. anginosus bacteremia. Imaging demonstrated hepatic lesions consistent with abscesses in the setting of pneumobilia and biliary stenting.

She was treated with intravenous ceftriaxone, resulting in rapid clinical and laboratory improvement, including resolution of leukocytosis and clearance of blood cultures. Although interventional radiology–guided drainage was recommended, the patient declined invasive management and opted for prolonged intravenous antibiotic therapy. She was discharged with a plan for 4–6 weeks of ceftriaxone via peripherally inserted central catheter, along with antiviral and hepatoprotective prophylaxis.

This case underscores the risk of infectious complications, including bacteremia and hepatic abscess formation, in immunocompromised patients undergoing repeated biliary interventions, and highlights the role of conservative management in select patients.

References

Jiang, S., Li, M., Fu, T., et al. (2020). Clinical characteristics of infections caused by Streptococcus anginosus group. Scientific Reports, 10, 9032.

Willcox, M. D., & Knox, K. W. (1990). Surface-associated properties of Streptococcus milleri group strains and their potential relation to pathogenesis. Journal of Medical Microbiology, 31, 259–264.

Scheithauer, B. K., Wos-Oxley, M. L., Ferslev, B., et al. (2009). Characterization of the complex bacterial communities colonizing biliary stents reveals a host-dependent diversity. ISME Journal, 3, 797–807.

Kodama, Y., Ishikawa, T., Shimoyama, Y., et al. (2018). The fibronectin-binding protein homologue Fbp62 of Streptococcus anginosus is a potent virulence factor. Microbiology and Immunology, 62, 624–632.

Jacobs, J. A., & Stobberingh, E. E. (1995). Hydrolytic enzymes of Streptococcus anginosus, Streptococcus constellatus, and Streptococcus intermedius in relation to infection. European Journal of Clinical Microbiology & Infectious Diseases, 14, 818–825.

Whiley, R. A., Beighton, D., Winstanley, T. G., et al. (1992). Streptococcus intermedius, Streptococcus constellatus, and Streptococcus anginosus (the Streptococcus milleri group): Association with different body sites and clinical infections. Journal of Clinical Microbiology, 30, 243–247.

Jiang, S., Li, M., Fu, T., et al. (2020). Clinical characteristics of infections caused by Streptococcus anginosus group. Scientific Reports, 10, 9032.

Santos, F. V., Pires, S. X., Pereira, C., et al. (2020). Deep neck space infection and Lemierre’s syndrome caused by Streptococcus anginosus: A case report. IDCases, 19, e00669.

Otto, W. R., Paden, W. Z., Connors, M., et al. (2021). Suppurative intracranial complications of pediatric sinusitis: A single-center experience. Journal of the Pediatric Infectious Diseases Society, 10, 309–315.

Shinzato, T., & Saito, A. (1995). The Streptococcus milleri group as a cause of pulmonary infections. Clinical Infectious Diseases, 21(Suppl 3), S238–S243.

Hannoodi, F., Ali, I., Sabbagh, H., & Kumar, S. (2016). Streptococcus intermedius causing necrotizing pneumonia in an immunocompetent female: A case report and literature review. Case Reports in Pulmonology, 2016, 7452161.

Porta, G., Rodríguez-Carballeira, M., Gómez, L., et al. (1998). Thoracic infection caused by Streptococcus milleri. European Respiratory Journal, 12, 357–362.

Pang, T. C., Fung, T., Samra, J., et al. (2011). Pyogenic liver abscess: An audit of 10 years’ experience. World Journal of Gastroenterology, 17, 1622–1630.

Masood, U., Sharma, A., Lowe, D., et al. (2016). Colorectal cancer associated with Streptococcus anginosus bacteremia and liver abscesses. Case Reports in Gastroenterology, 10, 769–774.

Law, S. T., & Kong, L. M. K. (2013). Is there any difference in pyogenic liver abscess caused by Streptococcus milleri and Klebsiella spp.? Retrospective analysis over a 10-year period in a regional hospital. Journal of Microbiology, Immunology and Infection, 46, 11–18.

Casariego, E., Rodriguez, A., Corredoira, J. C., et al. (1996). Prospective study of Streptococcus milleri bacteremia. European Journal of Clinical Microbiology & Infectious Diseases, 15, 194–200.

Junckerstorff, R. K., Robinson, J. O., & Murray, R. J. (2014). Invasive Streptococcus anginosus group infection: Does the species predict the outcome? International Journal of Infectious Diseases, 18, 38–40.

Bert, F., Bariou-Lancelin, M., & Lambert-Zechovsky, N. (1998). Clinical significance of bacteremia involving the Streptococcus milleri group: 51 cases and review. Clinical Infectious Diseases, 27, 385–387.

Laupland, K. B., Pasquill, K., Parfitt, E. C., et al. (2018). Streptococcus anginosus group bloodstream infections in the western interior of British Columbia, Canada. Infectious Diseases, 50, 423–431.

Chamat-Hedemand, S., Dahl, A., Østergaard, L., et al. (2020). Prevalence of infective endocarditis in streptococcal bloodstream infections is dependent on streptococcal species. Circulation, 142, 720–730.

Belko, J., Goldmann, D. A., Macone, A., & Zaidi, A. K. (2002). Clinically significant infections with organisms of the Streptococcus milleri group. Pediatric Infectious Disease Journal, 21, 715–723.

Van der Auwera, P. (1985). Clinical significance of Streptococcus milleri. European Journal of Clinical Microbiology, 4, 386–390.

Furuichi, M., & Horikoshi, Y. (2018). Sites of infection associated with Streptococcus anginosus group among children. Journal of Infection and Chemotherapy, 24, 99–103.

Seeto, R. K., & Rockey, D. C. (1996). Pyogenic liver abscess: Changes in etiology, management, and outcome. Medicine, 75, 99–113.

Kowlessar, P. I., O’Connell, N. H., Mitchell, R. D., et al. (2006). Management of patients with Streptococcus milleri brain abscesses. Journal of Infection, 52, 443–450.

Suzuki, H., Hase, R., Otsuka, Y., & Hosokawa, N. (2016). Bloodstream infections caused by Streptococcus anginosus group bacteria: A retrospective analysis of 78 cases at a Japanese tertiary hospital. Journal of Infection and Chemotherapy, 22, 456–460.

Bert, F., Bariou-Lancelin, M., & Lambert-Zechovsky, N. (1998). Clinical significance of bacteremia involving the Streptococcus milleri group: 51 cases and review. Clinical Infectious Diseases, 27, 385–387.

Ripley, R. T., Cothren, C. C., Moore, E. E., et al. (2006). Streptococcus milleri infections of the pleural space: Operative management predominates. American Journal of Surgery, 192, 817–821.