Fournier gangrene caused by Streptococcus agalactiae, Streptococcus anginosus, and Prevotella bivia with Alloscardovia omnicolens bacteremia

ABSTRACT

A 44-year-old man with morbid obesity and undiagnosed diabetes presented with the signs and symptoms of diabetic ketoacidosis (DKA) and sepsis secondary to necrotizing soft tissue infection of the right side of the perineum and scrotum. He received treatment for DKA and broad spectrum IV antibiotic coverage including vancomycin, clindamycin, and piperacillin-tazobactam and underwent surgical debridement to the gangrenous wound. The wound cultures from the perineum grew Streptococcus agalactiae, Streptococcus anginosus, and Prevoltella bivia; the blood culture grew Alloscardovia omnicolens. Antibiotics were changed to IV linezolid and IV piperacillin-tazobactam to cover these organisms. The patient received continued IV piperacillin-tazobactam for two weeks after the surgical debridement. A. omnicolens has been found to be a normal commensal of the oral cavity and the gastrointestinal tract; however, it has also been isolated from other tissue specimens, including pleural fluid in thoracic empyema, blood, urethra, and urine. There are limited data on the clinical significance of A. ominicolens; however, there have been multiple case reports on isolation of A. ominicolens in urine of patients with urinary tract infections (UTIs). It is noteworthy to find bacteremia due to A. omnicolens in the setting of Fournier gangrene.

Keywords: Alloscardovia omnicolens, Fournier gangrene, necrotizing soft tissue infections