GAS4 Hazards of ranching: Streptococus equinas may cause hepatic abscesses. (Gastroenterology).

GAS4 HAZARDS OF RANCHING: STREPTOCOCUS EQUINAS MAY CAUSE HEPATIC ABSCESSES. Danny C. Little, MD, and John Streitman, MD. Department of Gastroenterology, Scott & White Hospital, Temple, Tex.

A 77-year-old rancher presented to an outside institution with signs and symptoms consistent with acute bronchopulmonary pneumonia. He was appropriately treated with antibiotics as an outpatient. During his initial workup he was found to have an elevated alkaline phosphatase. Given a recent history of fever, chills, weight loss, and night sweats, a computerized tomography was ordered and revealed multiple hepatic masses consistent metastatic disease. A formal metastatic workup was ordered. Two weeks later the patient presented to our institution with fever, tachycardia, and leukocytosis. He was found to have an acute abdomen and emergently taken to the operating room. During exploratory celiotomy a ruptured right hepatic abscess was discovered. A contained left hepatic abscess was also noted. Drains were placed. Blood cultures remained negative; however, wound cultures grew Streptococcus equinas. The patient was discharged on postoperative day 8 without sequelae. Pyogenic hepatic abscesses most commonly arise from biliary tract disease, contiguous spread, trauma, or portal venous seeding/embolization. Symptoms include fever, weakness, rigors, anorexia, and weight loss. Signs include hepatomegaly, abdominal pain, jaundice, and pleural effusion. Streptococcus equinas is an alpha hemolytic gram positive cocci found primarily in the gastrointestinal tract of horses. In horses, this bacteria may cause copious nasal discharge, fever, and anorexia. This disease, named Strangles, is one of the most important diseases affecting horses. Human case reports are exceedingly rare. We report a rare case of S. equinas causing life threatening multiple hepatic abscesses in a rancher.