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Images in neonatal medicine
Late-onset group B streptococcal cellulitis
  1. Tobias Strunk1,2,
  2. David Burgner3,4
  1. 1 Neonatal Clinical Care Unit, King Edward Memorial Hospital
  2. 2 Centre for Neonatal Research and Education, School of Paediatrics and Child Health, The University of Western Australia, Perth, Western Australia, Australia
  3. 3 Murdoch Childrens Research Institute, Royal Children's Hospital, Parkville, Victoria, Australia
  4. 4 Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia
  1. Correspondence to Dr Tobias Strunk, Neonatal Clinical Care Unit, King Edward Memorial Hospital, Centre for Neonatal Research and Education, School of Paediatrics and Child Health, The University of Western Australia, 374 Bagot Road, Subiaco, WA 6008, Australia; tobias.strunk{at}health.wa.gov.au or tobiasstrunk{at}yahoo.de

https://doi.org/10.1136/archdischild-2014-307388

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    A 33-week gestational age female infant was delivered by non-elective caesarean section for intrauterine growth restriction (birth weight 1130 g). She received continuous positive airway pressure support for 72 h and empiric penicillin and gentamicin for 48 h. Initial blood culture, full blood count and C reactive protein were normal. The maternal Group B streptococci (GBS) status was unknown. She was fully enterally fed with expressed breast milk on day 6 of life. On day 12, she developed rapidly progressive erythema in the napkin area with a violaceous hue that spread to her lower abdomen and back (figures 1 and 2). Her blood culture grew group B streptococcus (Streptococcus agalactiae). There was no evidence of meningitis. Within 12 h of starting empirical antibiotics, the cellulitis improved. Our patient completed a 10-day course of benzylpenicillin with full resolution of skin changes and remained well until discharge. Cellulitis-adenitis syndrome, particularly of the face and neck region, is a recognised, but uncommon presentation of late-onset GBS disease in preterm infants and may be the primary sign of GBS sepsis.1 ,2 In neonates, especially in those born preterm, GBS cellulitis can be complicated by bacteraemia and/or meningitis and, therefore, blood culture and lumbar puncture should always be performed to guide optimal duration of therapy.3

    Figure 1
    Figure 1

    Front view

    Figure 2
    Figure 2

    Back view

    References

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      . Group B streptococcal cellulitis-adenitis in infants. Am J Dis Child 1982;136:631–3.
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      2. Kalliola S ,
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      . Neonatal group B streptococcal disease in Finland: a ten-year nationwide study. Pediatr Infect Dis J 1999;18:806–10.
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    3. ↵
      2. Albanyan EA ,
      3. Baker CJ
      . Is lumbar puncture necessary to exclude meningitis in neonates and young infants: lessons from the group B streptococcus cellulitis- adenitis syndrome. Pediatrics 1998;102 (4 Pt 1):985–6.
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    Footnotes

    • Contributors TS cared for the patient. TS and DB wrote the case report.

    • Competing interests None.

    • Patient consent Obtained.

    • Provenance and peer review Not commissioned; externally peer reviewed.