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Streptococcus subpectoral abscess with shoulder pain: A rare emergency with a common symptom?

International Journal of Shoulder Surgery
Medknow Publications
Publication Date
DOI: 10.4103/0973-6042.68419
  • Letter To Editor
  • Biology
  • Logic


Sir, Lancefield group A beta-hemolytic streptococcus (GABHS) is known to cause a wide range of infections. However shoulder pain due to isolated subpectoral abscess caused by group A beta haemolytic streptococcus is extremely rare with only two previously reported cases in the literature.[12] The onset may be insidious and patient may appear well on initial presentation. The clinical course is varied but sometimes precipitous associated with high morbidity and mortality. We describe the third case of painful shoulder in a teenage boy due to subpectoral abscess caused by this organism. A 16-year-old otherwise healthy boy presented to the outpatient orthopaedic clinic with chief complaint of pain in the right shoulder. 2 weeks prior to this presentation he had an episode of sore throat for which he was treated by his general practitioner with paracetamol. A week later he noticed pain in his right shoulder. There was no history of recent infection to the right arm or hand, trauma, insect bite animal exposure, or recent travel. On physical examination he was a well-built and well-nourished boy. Inspection revealed erythema and fullness of the right supraclavicular fossa and pectoral region. There was no bruise, scars or other lesions on the overlying skin. He had an oral temperature of 38.6°C and a pulse rate of 90/min. He had tenderness around right axilla with no palpable lymphadenopathy. External rotation and active abduction beyond 90° were painful in the right shoulder. The remainder of shoulder movements were normal. Preliminary blood tests revealed that white blood cell count was 24300/mm3 with 85% neutrophils, 10% lymphocytes, 4% monocytes, 0.6% eosinophils, 0.1% basophils with erythrocyte sedimentation rate of 84 mm/hr, and C-reactive protein level of 224 mg/dl. Blood and urine cultures were obtained. Chest and right shoulder radiographs revealed no significant abnormality. Ultrasound scan of the right shoulder and the pectoral region showed a loculated collection deep to the pectora

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