Streptococcus milleri sepsis with lung and brain abscesses

Streptococcus milleri sepsis with lung and brain abscesses. A 69-year old man developed a clinical picture in two phases. A Streptococcus milleri sepsis with metastatic endophtalmitis was treated during 3 weeks with conventional doses amoxycillin/clavulanate with apparently positive clinical evolution. Shortly afterwards he developed a second episode of sepsis with, documented on CT-scan, multiple lung abscesses and a solitary brain abscess. Cultures of the brain abscess were also positive for S. milleri. In the end a slow but complete recovery was seen under high doses penicillin and clindamycin IV. The different species of the Streptococcus milleri group (SMG) are part of the normal flora of the mouth, the vagina, the respiratory and the gastrointestinal tract. In the vast majority of cases SMG bacteremia is preceded by local trauma to the mucosal barrier. Although these bacteremic episodes are often transient, metastatic purulent lesions, especially in the abdominal and thoracic cavities, may complicate them. Multiple positive blood cultures or polymicrobial bacteremia strongly suggest a suppurative focus of infection and should prompt clinicians to initiate further thorough investigations. Cornerstones of effective treatment are intravenous antimicrobial therapy and surgical drainage in case of abcedation. Since SMG largely remain susceptible, penicillin stays the treatment of choice. Yet, the frequent polymicrobial nature of these infections often necessitates initial broad-spectrum antimicrobial coverage