# Abdominal and Back Pain Initially Suspected to Be Transient Intestinal Ischemia in a Case of Streptococcus dysgalactiae subsp. equisimilis Bacteremia

## TL;DR

An elderly man with abdominal and back pain was found to have a rare bacterial infection that can cause unusual symptoms before skin lesions appear.

## Contribution

This case highlights SDSE bacteremia as a potential cause of nonspecific abdominal and back pain, even before skin symptoms develop.

## Key findings

- An 87-year-old man with abdominal and back pain was diagnosed with SDSE bacteremia after initial suspicion of intestinal ischemia.
- Symptoms improved with antimicrobial therapy, suggesting bacteremia-related circulatory disturbances caused the pain.
- The case emphasizes the need to consider SDSE as a cause of atypical symptoms in elderly or comorbid patients.

## Abstract

Streptococcus dysgalactiae subsp. equisimilis (SDSE) has been increasingly recognized as a causative pathogen of skin and soft tissue infections and bacteremia, particularly in elderly individuals or those with underlying comorbidities. It typically presents with fever and localized pain associated with cellulitis; however, it may occasionally manifest with nonspecific symptoms, leading to diagnostic delay.

We report the case of an 87-year-old man who presented with abdominal and lower back pain, initially suspected to have intestinal ischemia based on contrast-enhanced computed tomography findings and elevated serum lactate levels, but was later diagnosed with SDSE bacteremia following positive blood cultures and subsequent identification of cellulitis between the right third and fourth toes.

After initiation of antimicrobial therapy with ampicillin/sulbactam and intravenous fluids, his fever and inflammatory response improved. Based on the clinical course, it was suggested that bacteremia-related circulatory disturbances and transient intestinal ischemia might have contributed to the nonspecific abdominal and back pain.

This case highlights the importance of recognizing SDSE bacteremia as a potential etiology of atypical initial symptoms - such as abdominal or back pain - even before the development of overt skin lesions.