Korean J Pediatr Infect Dis KJPID Korean Journal of Pediatric Infectious Diseases 1226-3923 The Korean Society of Pediatric Infectious Diseases 10.14776/kjpid.2012.19.3.157 Case Report Acute Acalculous Cholecystitis with Bacteremia Caused by Streptococcus anginosus Following Dental Procedure in a Previously Healthy Adolescent Kim Hyun O M.D. Yum Sook Kyung M.D. Han Seung Beom M.D. Kwon Hyo Jin M.D. * Kang Jin Han M.D. Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul, Korea. Department of Pediatrics, College of Medicine, Korea University, Seoul, Korea. Correspondence: Jin Han Kang, M.D. Department of Pediatrics, Seoul St. Mary's Hospital, Seoul, Korea. Tel: +82-2-2258-6183, Fax: +82-2-537-4544, kjhan@catholic.ac.kr 12 2012 31 12 2012 19 3 157 161 14 09 2012 22 10 2012 22 10 2012 Copyright © 2012 The Korean Society of Pediatric Infectious Diseases 2012

Streptococcus anginosus is a member of Streptococcus milleri group, and is found in the oral mucosa, respiratory tract, and gastrointestinal tract as normal flora. It can develop into a disease in patients with deteriorating clinical condition or with clinical risk factors. A previously healthy 15-year-old boy was admitted due to fever, abdominal discomfort and vomiting which lasted for 7 days. He had a history of dental procedure 1 day before the development of fever. He was diagnosed with acute acalculous cholecystitis based on the clinical, laboratory, and imaging finding, and S. anginosus was isolated from the blood culture. The patient was successfully treated with antibiotic therapy.

 Streptococcus anginosus Cholecystitis Bacteremia Ruoff KL Streptococcus anginosus ("Streptococcus milleri"): the unrecognized pathogen Clin Microbiol Rev 1988 1 102 108 Claridge JE 3rd Attorri S Musher DM Hebert J Dunbar S Streptococcus intermedius, Streptococcus constellatus, and Streptococcus anginosus ("Streptococcus milleri group") are of different clinical importance and are not equally associated with abscess Clin Infect Dis 2001 32 1511 1515 Poole PM Occurrence and cultural features of Streptococcus milleri in various body sites J Clin Pathol 1979 32 764 768 Salavert M Gómez L Rodriguez-Carballeira M Xercavins M Freixas N Garau J Seven-year review of bacteremia caused by Streptococcus milleri and other viridans streptococci Eur J Clin Microbiol Infect Dis 1996 15 365 371 Admon D Ephros MA Gavish D Raz R Infection with Streptococcus milleri J Infect 1987 14 55 60 Tsakayannis DE Kozakewich HP Lillehei CW Acalculous cholecystitis in children J Pediatr Surg 1996 31 127 130 Imamoğlu M Sarihan H Sari A Ahmetoğlu A Acute acalculous cholecystitis in children: diagnosis and treatment J Pediatr Surg 2002 37 36 39 Ternberg JL Keating JP Acute acalculous cholecystitis. Complication of other illnesses in childhood Arch Surg 1975 110 543 547 Lo WT Wang CC Chu ML Acute septicaemic acalculous cholecystitis complicated by empyema caused by Salmonella group D in a previously healthy child Eur J Pediatr 2002 161 575 577 Sams RN Haltiner AL Botse-Baidoo E Coomer C Moosariparambil M Catto BA First report of Streptococcus bovis-associated acute cholecystitis in North America J Clin Gastroenterol 2008 42 959 960 Batra V Ang JY Asmar BI Staphylococcal acalculous cholecystitis in a child South Med J 2003 96 206 208 Gora-Gebka M Liberek A Bako W Szarszewski A Kamińska B Korzon M Acute acalculous cholecystitis of viral etiology-a rare condition in children? J Pediatr Surg 2008 43 e25 e27 Mourani S Dobbs SM Genta RM Tandon AK Yoffe B Hepatitis A virus-associated cholecystitis Ann Intern Med 1994 120 398 400 Bert F Bariou-Lancelin M Lambert-Zechovsky N Clinical significance of bacteremia involving the "Streptococcus milleri" group: 51 cases and review Clin Infect Dis 1998 27 385 387

Ultrasonography of the abdomen demonstrates diffuse edematous wall thickening of gallbladder.

Computed tomography of the abdomen. (A) Edematous gallbladder wall thickening with pericholecystic edema on admission. (B) Regression of the gallbladder lesion 1 month later.