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A 23-year old man had complained of right lower quadrant abdomonal pain for approximately one week. Initially the pain was sharp and localized to a small area just above the right iliac crest.The pain subsided for approximately two days, but then recurred more diffusely over the lower abdomen, accompanied by cramping and mild diarrhea.The onset of fever and vomiting promted a visit to the emergency room. His temperature was 101 F, pulse was 90/minute, and palpation of the right lower abdomen elicited severe pain.The white blood count was 23,000/mm with a distinct left shift, including 5% metamyelocytes.Emergency surgery was performed for a large peri-appendiceal abscess. During surgery, multiple abscesses were noted in the spleen, which was removed (see photograph).Recovery was uneventful following 5 days of adjuvant clindamycin therapy.

Gelfand MS. Bakhtian BJ. Simmons BP.: Spinal sepsis due to Streptococcus milleri: two cases and review. Reviews of Infectious Diseases. 13:559-63, 1991We have recently cared for two patients with spinal sepsis secondary to infection with Streptococcus milleri.One patient had a spinal epidural abscess and the other had meningitis as well as a spinal subdural empyema.A review of the English-language literature revealed only two previously reported cases of spinal epidural abscess due to S. milleri and no cases of spinal subdural empyema due to S. milleri. We report two cases of spinal sepsis due to S. milleri and discuss pertinent literature.

Newfield RS. Vargas I. Huma Z.: Eikenella corrodens infections. Case report in two adolescent females with IDDM. Diabetes Care. 19:1011-3, 1996OBJECTIVE: To alert physicians caring for patients with diabetes to the microorganism Eikenella corrodens and to discuss the appropriate preventive and therapeutic measures to take against this potentially morbid opportunistic Gram-negative bacilli.CASES: We present two cases of extra-oral E. corrodens infections in adolescent females with IDDM. The first patient had diabetes of 4 years' duration, which was moderately well controlled. Chronic finger biting resulted in a complex felon that evolved gradually and worsened while the patient received cephalexin orally. Delay in seeking further intervention resulted in necrosis of her distal fingertip and nail bed. The second patient had poorly controlled diabetes for 5 years. She developed an acute thigh abscess at an insulin injection site that resolved after drainage and intravenous antibiotics.CONCLUSIONS: E. corrodens commonly inhabits the human oral cavity and becomes a pathogen mostly when host defenses are impaired, causing abscesses and infections that are at times fatal. Patients with IDDM are compromised hosts and with daily microtrauma to their skin via glucose monitoring and insulin injections, are prone to develop E. corrodens infections that can be introduced through oral secretions by licking or biting their skin. Educational efforts aimed at preventing exposure of traumatized skin to oral secretions can minimize the risk of E. corrodens infections in compromised hosts.Early intravenous administration of antibiotics, bearing in mind E. corrodens resistance to clindamycin, metronidazole, and other antibiotics, coupled with prompt surgical intervention, is essential in successfully managing E. corrodens infections.