Case and Research Letters
Gluteal Abscess due to Finegoldia Magna in a Patient with Diabetes
Absceso glúteo por finegoldia magna en un paciente diabético
B. Arencibia-Pérez
, O. Benet-Muñoz, C. Roque-Castellano, J. Marchena-Gómez
Corresponding author
Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario de Gran Canaria Dr. Negrín, Las Palmas, Spain
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Arencibia-Pérez, O. Benet-Muñoz, C. Roque-Castellano, J. Marchena-Gómez" "autores" => array:4 [ 0 => array:4 [ "nombre" => "B." "apellidos" => "Arencibia-Pérez" "email" => array:1 [ 0 => "bearenci@gmail.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "O." "apellidos" => "Benet-Muñoz" ] 2 => array:2 [ "nombre" => "C." "apellidos" => "Roque-Castellano" ] 3 => array:2 [ "nombre" => "J." "apellidos" => "Marchena-Gómez" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario de Gran Canaria Dr. Negrín, Las Palmas, Spain" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Absceso glúteo por finegoldia magna en un paciente diabético" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 731 "Ancho" => 905 "Tamanyo" => 87107 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Abscess on the left buttock with active suppuration and a large (10 cm) area of necrosis.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Finegoldia magna</span> is a strictly anaerobic gram-positive coccus that is part of the commensal flora of the skin, oral cavity, gastrointestinal tract, and the female urogenital tract.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,2</span></a> We describe an unusual case of a complicated gluteal abscess caused exclusively by an opportunistic pathogen in a patient with diabetes mellitus who had not received previous intramuscular injections in the affected area.</p><p id="par0010" class="elsevierStylePara elsevierViewall">A 60-year-old man came to the emergency department with intense pain and suppuration in the left buttock that had begun 2 weeks earlier. The patient’s past history included hypertension, dyslipidemia, overweight (body mass index, 29), vitiligo, active smoking (20 cigarettes per day), and type 2 diabetes mellitus of 12 years duration with good glycemic control without evidence of metadiabetic complications (HbA1, 7%), although he reported worsening of glycemic control at home in recent weeks, coinciding with the infectious process. The patient reported no previous gluteal intramuscular injections. He was being treated with acetylsalicylic acid (100 mg/24 h), atorvastatin (10 mg/24 h), glimepiride (2 mg/24 h), and bisoprolol (5 mg/24 h).</p><p id="par0015" class="elsevierStylePara elsevierViewall">Physical examination revealed a large, painful, hot fluctuant swelling on the left buttock accompanied by crepitus and active suppuration, and a necrotic area of 10 cm (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). Laboratory tests revealed the following: hemoglobin, 15 g/dL; leukocytes; 10 870 mm<span class="elsevierStyleSup">3</span>; platelets, 121 000 mm<span class="elsevierStyleSup">3</span>; prothrombin time, 16%; glucose, 370 mg/dL; urea, 67 mg/dL; creatinine, 1.25 mg/dL; lactic acid 2 mmol/L; procalcitonin, 1.19 ng/mL; C-reactive protein, 249 mg/L.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">Based on the clinical findings the patient underwent emergency drainage in the operating room. A liter of pus was extracted, samples were taken for culture, and wide excision of the necrotic tissue was performed. During the postoperative period the patient showed a favorable clinical course, recovering glycemic control and mobility and functionality of the left leg.</p><p id="par0025" class="elsevierStylePara elsevierViewall">Abscess cultures were negative for aerobic bacteria and positive only for strictly anaerobic gram-positive cocci, which bacterial typing identified as <span class="elsevierStyleItalic">F magna</span>. An antibiogram for <span class="elsevierStyleItalic">F magna</span> revealed sensitivity to amoxicillin-clavulanic acid, metronidazole, and clindamycin, and no evidence of antibiotic resistance. The patient was discharged from hospital and prescribed antibiotic treatment (metronidazole, 500 mg/8 h) and outpatient surgical wound care, to which he responded well.</p><p id="par0030" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">F magna,</span> previously known as <span class="elsevierStyleItalic">Peptostreptococcus magnus,</span> has undergone multiple taxonomic changes since it was first described in 1933 by Prevot, who used the term <span class="elsevierStyleItalic">Diplococcus magnus.</span><a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">F magna</span> is probably the most common of all gram-positive anaerobic cocci (GPAC) and the most pathogenic form found in human clinical samples. This microorganism is part of the normal biota and is found predominantly in the skin, gastrointestinal tract, female genitourinary tract, and, to a lesser extent, the oral cavity.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,2</span></a> In recent years, 2 important proteins have been identified that explain the virulence and colonization capacity of <span class="elsevierStyleItalic">F magna</span>: the surface adhesion protein FAF (<span class="elsevierStyleItalic">F magna</span> adhesion factor) and the subtilisin-like serine protease SufA.<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2,4</span></a> In the upper layers of the epidermis, FAF mediates adhesion by binding to galectin-7, a keratinocyte cell marker. After bacteria move deeper into the skin and reach the basal membrane, SufA breaks down collagen IV. In the dermis, FAF interacts with collagen V and fibrillin, which presumably explains how <span class="elsevierStyleItalic">F magna</span> can reach the deepest layers of dermal tissue during infection.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">F magna</span> is one of the species most commonly cultured from abscesses of the skin, soft tissues, bones and joints, usually in polymicrobial cultures, and in rare cases in pure cultures.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> Postoperative mediastinitis, prosthetic valve endocarditis, and necrotizing pneumonia due to <span class="elsevierStyleItalic">F magna</span> have been described.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> The use of broad-spectrum antibiotics that alter the skin microbiota, the introduction of foreign materials (prosthetic valves, replacement joints, catheters), and an increase in the number of patients treated with immunosuppressive drugs favor these infections by creating an optimal environment for these opportunistic pathogens.</p><p id="par0045" class="elsevierStylePara elsevierViewall">Antimicrobial resistance among anaerobic bacteria is increasing worldwide.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> Most GPACs (>90%) are susceptible to penicillin, and many are also susceptible to other β-lactam antibiotics,<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">7–10</span></a> but show increasing resistance to other antibiotics such as clindamycin, metronidazole, and fluoroquinolones.<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">8–10</span></a> Rates of clindamycin resistance among GPACs range from 7% to 20%, but are increasing in certain species, including <span class="elsevierStyleItalic">F magna</span> and <span class="elsevierStyleItalic">Peptoniphilus</span> species.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> Most GPACs are still susceptible to metronidazole, although some metronidazole-resistant strains of <span class="elsevierStyleItalic">F magna</span> and <span class="elsevierStyleItalic">Parvimonas micra</span> have been described.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a></p><p id="par0050" class="elsevierStylePara elsevierViewall">The present case illustrates how the commensal bacterium <span class="elsevierStyleItalic">F magna</span> is capable of producing an advanced necrotizing infection, and underscores the importance of species-level identification and determination of the antimicrobial sensitivity of anaerobic bacteria from representative samples when isolated in pure cultures.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflicts of Interest</span><p id="par0055" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:2 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Conflicts of Interest" ] 1 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Arencibia-Pérez B, Benet-Muñoz O, Roque-Castellano C, Marchena-Gómez J. Absceso glúteo por finegoldia magna en un paciente diabético. Actas Dermosifiliogr. 2020;111:527–528.</p>" ] ] "multimedia" => array:1 [ 0 => array:8 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 731 "Ancho" => 905 "Tamanyo" => 87107 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Abscess on the left buttock with active suppuration and a large (10 cm) area of necrosis.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:10 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Antianaerobic antimicrobials: spectrum and susceptibility testing" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "I. 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 7 | 3 | 10 |
| 2024 October | 282 | 48 | 330 |
| 2024 September | 331 | 56 | 387 |
| 2024 August | 335 | 51 | 386 |
| 2024 July | 394 | 41 | 435 |
| 2024 June | 283 | 49 | 332 |
| 2024 May | 255 | 49 | 304 |
| 2024 April | 243 | 26 | 269 |
| 2024 March | 260 | 27 | 287 |
| 2024 February | 259 | 30 | 289 |
| 2024 January | 304 | 44 | 348 |
| 2023 December | 298 | 29 | 327 |
| 2023 November | 345 | 58 | 403 |
| 2023 October | 339 | 54 | 393 |
| 2023 September | 309 | 46 | 355 |
| 2023 August | 226 | 24 | 250 |
| 2023 July | 252 | 49 | 301 |
| 2023 June | 226 | 36 | 262 |
| 2023 May | 344 | 35 | 379 |
| 2023 April | 291 | 36 | 327 |
| 2023 March | 228 | 39 | 267 |
| 2023 February | 214 | 25 | 239 |
| 2023 January | 213 | 31 | 244 |
| 2022 December | 171 | 33 | 204 |
| 2022 November | 181 | 31 | 212 |
| 2022 October | 142 | 31 | 173 |
| 2022 September | 140 | 51 | 191 |
| 2022 August | 103 | 52 | 155 |
| 2022 July | 81 | 55 | 136 |
| 2022 June | 37 | 39 | 76 |
| 2022 May | 238 | 54 | 292 |
| 2022 April | 319 | 36 | 355 |
| 2022 March | 321 | 41 | 362 |
| 2022 February | 308 | 44 | 352 |
| 2022 January | 300 | 34 | 334 |
| 2021 December | 250 | 51 | 301 |
| 2021 November | 239 | 50 | 289 |
| 2021 October | 302 | 66 | 368 |
| 2021 September | 231 | 55 | 286 |
| 2021 August | 268 | 74 | 342 |
| 2021 July | 341 | 32 | 373 |
| 2021 June | 381 | 35 | 416 |
| 2021 May | 333 | 41 | 374 |
| 2021 April | 606 | 69 | 675 |
| 2021 March | 294 | 27 | 321 |
| 2021 February | 184 | 31 | 215 |
| 2021 January | 192 | 12 | 204 |
| 2020 December | 86 | 25 | 111 |
| 2020 November | 63 | 17 | 80 |
| 2020 October | 61 | 27 | 88 |
| 2020 September | 56 | 28 | 84 |
| 2020 August | 52 | 18 | 70 |
| 2020 July | 20 | 20 | 40 |
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