Recurrent neonatal group B streptococcus cellulitis and adenitis syndrome with late-onset sepsis
-
Alex Guri
,
Eric Scheier
Abstract
Objectives
Group-B streptococcus (GBS) continues to be a significant cause of late-onset neonatal illness. Rarely does it present as cellulitis-adenitis syndrome, and rarely does the infection recur in the same infant after complete recovery.
Case presentation
Here we report a case of recurrent late-onset cellulitis-adenitis GBS syndrome in a term 12-day-old neonate. The infant presented with fever and cellulitis of the right neck. Full sepsis workup was normal and the infant recovered completely with antibiotics. Three days after the completion of antibiotics the patient returned to the emergency department due to fever, toxic appearance and rapidly spreading cellulitis, and adenitis on the left side of the neck. Blood culture revealed GBS. The patient was re-admitted to the hospital and successfully treated with a prolonged course of antibiotics.
Conclusions
This case highlights the importance of treating neonatal cellulitis with fever as bacteremia, and reminds us of the rare possibility of recurrent invasive GBS disease. Moreover, this case illustrates that GBS cellulitis-adenitis syndrome is possibly underdiagnosed in mild cases. Physicians should be aware that neonatal cellulitis can precede the appearance of severe sepsis. Neonates with fever and cellulitis without a clear external port of entry should undergo a complete sepsis workup and receive antibiotic treatment appropriate for bacteremia, even if the blood cultures are negative. Although the recurrence of GBS sepsis is rare, physicians should be aware of this possibility in order to treat the infection early.
Research funding: None declared.
Author contributions: All authors have accepted responsibility for the entire content of this manuscript and approved its submission.
Competing interests: Authors state no conflict of interest.
Informed consent: Informed consent for publication was obtained from the patient's parents.
Ethical approval: Research involving human subjects complied with all relevant national regulations, institutional policies and is in accordance with the tenets of the Helsinki Declaration (as revised in 2013), and has been approved by the authors' Institutional Review Board or equivalent committee.
References
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