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Granulicatella adiacens Producing an Interesting Etiology of Cellulitis status post Mastectomy
Lundrim Marku, BS, MSc1
Rebecca Norcini MD2
Kerri Woodberry, MD2
West Virginia School of Medicine
2023-02-08
Presenter: Lundrim Marku
Affidavit:
To whom It may concern:
This research has not been published elsewhere not presented at a major meeting.
Kerri M. Woodberry, MD, MBA, FACS
Division Chief
Plastic and Reconstructive Surgery/
Hand Surgery
Residency Program Director
Associate Professor
WVU Medicine
One Medical Center Drive
PO Box 9238
Morgantown, WV 26506-9238
Phone 304-293-3311
Fax 304-293-2556
kerri.woodberry@hsc.wvu.edu
Director Name: Kerri Woodberry
Author Category: Medical Student
Presentation Category: Clinical
Abstract Category: General Reconstruction
A 44-year-old female status post right skin-sparing mastectomy, axillary lymph node dissection with immediate reconstruction, and tissue expander implant present with two weeks of increasing erythema along the medial and lateral portions of the incision and a "burning" sensation (Figure 1). Dehiscence of the lateral portion of the incision was noted, and the incision was not draining. The patient's labs were unremarkable, and she was admitted and started on IV cefepime and vancomycin for breast cellulitis. Symptoms remained unchanged over the next days, and the patient was taken to the operating room for tissue expander removal, washout, and drain placement. The microbiology specimen gathered during the operation grew Granulicatella adiacens. On postoperative day two, the patient's pain improved and was stable for discharge. At the three-follow-up visit, the burning pain returned with serous drainage from the lateral portion of the incision and worsening erythema (Figure 2).
G.adiacens is a nutritionally variant streptococcus species that requires fastidious growth environments and is challenging to isolate. As a result, G.adiacens is often dismissed as a part of polymicrobial infections. G.adiacens is uncommonly found in breast implant infections and prosthetic joint infections. In prosthetic joint infections, G. adiacens has been found to cause secondary infections after a group A beta-hemolytic streptococcus or Staphylococcus aureus infection. Infections can lead to a problematic treatment course that requires debridement, irrigation, and a prolonged antimicrobial course. G. adiacens has been reported in a few breast implant cases but is an exceedingly rare cause of tissue expander infections.
