Not the First Case Ever
Mark Crislip
The patient is an almost healthy female who, three days prior to admission, had her right groin catheterized as part of examining her coronary arteries.
She came in with fevers, rigors, and a red hot swollen groin.
Cellulitis.
OK.
She was started on vancomycin, and the next day I was called when both sets of blood cultures had gram-positive cocci in chains.
By the time I saw her, the erythroderma and pain at admit had nearly resolved. Kind of quick to get better.
It's going to be a Group A Streptococcus or maybe another Streptococcus. And there are the occasional pseudoaneurysms after angiography, so beware the Enterococcus.
We looked. No pseudoaneurysm.
But the next day, the organism was identified as Abiotrophia defectiva.
That's odd. A quick Pubmed found no cases of Abiotrophia defectiva as a cause of cellulitis, and it is a mouth organism. Yeah, the mouth and rectum are connected, but it seemed a stretch.
The closest was
We report a case of infective endocarditis (IE) caused by Abiotrophia defectiva in an 8 year-old boy presented initially with left ankle cellulitis and fever.
Went back to the patient armed with the microbiology. No murmur, no emboli, no nothing except on direct questioning he had three teeth extracted several days before the catheterization.
And the TEE showed a small vegetation on the aortic valve. While not the firest case ever of primary Abiotrophia cellulitis, it is the first case in an adult of endocarditis due to Abiotrophia defectiva presenting as cellulitis. I'll take it.
Rationalization
Iatrogenic femoral artery pseudoaneurysms--a review of current methods of diagnosis and treatment https://pubmed.ncbi.nlm.nih.gov/18996260/
Infective Endocarditis due to Abiotrophia defectiva presenting as Ankle Cellulitis https://www.semanticscholar.org/paper/Infective-Endocarditis-due-to-Abiotrophia-defectiva-Subhi-Yaqubi/a6f827a53def581f9ed509ea93fd665425ad5d8d