Multi-regional abscesses caused by streptococcus milleri following acupuncture

ABSTRACT

We report a case of multiregional abscesses following acupuncture. A 56-year-old female who had received acupuncture to treat lower back pain, subsequently develops lumbar septic arthritis, epidural abscess, bilateral iliopsoas, and subcutaneous abscesses. Streptococcus milleri was isolated from the peripheral blood, subcutaneous tissue and psoas abscess. Surgical drainage of the subcutaneous abscess, CT guided drainage of the intraabdominal abscess and intravenous ceftriaxone resulted in a good clinical recovery, resolution of the infection, and prevention of complications. The case is discussed in detail, and pertinent review of literature is included. Streptococcus milleri naturally occurs as normal flora of the mouth, nasopharynx, gastrointestinal tract, and vagina. They were first described by Dr O Guthof in 1956 in honour of Dr WD Miller, an oral microbiologist. They are generally sensitive to penicillins, cephalosporins, vancomycin, and clindamycin. They are resistant to bacitracin, and sulphonamides. Infections caused by streptococcus milleri include oral infections, deep abscesses in liver, brain, spinal cord, and lung. They rarely occur in the pericardium, pleura, surgical wounds, endocarditis, and can cause bacteremia in both immunocompromised and immunocompetent hoste[l]. We present a case of a 56-year-old female who developed lumbar septic arthritis, epidural abscess, bilateral iliopsoas, and subcutaneous abscesses due to streptococcus milleri infection after receiving lower back and gluteal acupuncture for relief of musculoskeletal back pain. To the best of our knowledge, this is the first reported case in the literature