Infect Chemother IC Infection and Chemotherapy 1598-8112 The Korean Society of Infectious Diseases and The Korean Society for Chemotherapy 10.3947/ic.2008.40.5.281 Case Report A Case of Humeral Osteomyelitis and Soft Tissue Abscess Accompanied with Streptococcus anginosus Bacteremia Han Woo Jin M.D. 1 Cho Moon Sook M.D. 1 Lee Jung Hyun M.D. 1 Ahn Hong-Dae M.D. 1 Yoon Kyu Hyun M.D. 1 Seo Jong Goo M.D. 1 Kim Jin Yong M.D. 1 Kim Sue-Yun M.D. 1 Park Yoon Soo M.D. 1 Seo Yiel-Hae M.D. 2 Cho Yong Kyun M.D. 1 Department of Internal Medicine, Gachon University, Gil Medical Center, Incheon, Korea. Department of Laboratory Medicine, Gachon University, Gil Medical Center, Incheon, Korea. Correspondence: Yoon Soo Park, M.D. Department of Internal Medicine, Gachon University, Gil Medical Center, 1198, Guwol-dong, Namdong-gu, Incheon, 405-760, Korea. Tel: +82-32-460-3430, Fax: +82-32-472-1578, yspark@gilhospital.com Sep-Oct 2008 25 10 2008 40 5 281 283 09 06 2008 26 08 2008 Copyright © 2008 The Korean Society of Infectious Diseases and The Korean Society for Chemotherapy 2008

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Streptococcus anginosus is a normal flora found in multiple body sites and belongs to the Streptococcus milleri group. It has often been associated with pyogenic infection, such as perio-dontitis, endocarditis, pulmonary abscess and abdominal or cerebral abscess. Also uncommonly, it can cause osteomyelitis. A 42-year-old man was admitted due to gastric ulcer perforation. At 12th hospital day, left humeral osteomyelitis and soft tissue abscess developed. Streptococcus anginosus grew in blood culture. He was treated with intravenous penicillin and surgical debridement of the necrotic tissue which lead to a satisfactory result. We report a rare case of Streptococcus anginosus-induced humeral osteomyelitis and soft tissue abscess.

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Lt. shoulder AP image reveals soft tissue swelling at the left upper arm with internal air bubbles which suggest of gas forming infection. There is no definite evidence of bony abnormalities.

(A) On left shoulder T1-weighted and (B) T2-weighted MRI, the left proximal humerus shows diffuse heterogeneous signal intensity on T2WI with irregular enhancement on gadolinium administration suggesting bone marrow involvement. There is an abscess, measuring about 7×5 cm, around the proximal humerus showing heterogeneous high signal intensity on T2WI with peripheral enhancement on sagittal gadolinium enhanced T1WI.