Ulett et al. Journal of Medical Case Reports 2012, 6:237 http://www.jmedicalcasereports.com/content/6/1/237 Page 3 of 4 Figure 1 Computed tomography scans showing a large abscess within the patient’s pelvis that was culture positive for S. agalactiae. Transverse (A) and coronal (B) contrast-enhanced computed tomography scans of the patient showing a large abscess within her pelvis extending to the right adnexa (arrow) that was culture positive for S. agalactiae. Near complete resolution was achieved (C) one day after fluoroscopic-guided abscess drainage. secondary abscesses and device-related infections. Sporadic cases of non-abdominopelvic secondary GBS abscesses in adults have been reported in the litera- ture; a review using the PubMed database (from 1966 to current; English) with the terms “group B strepto- coccus,” and “Streptococcus agalactiae,” and “abscess” identified 60 cases comprising subcutaneous (23), retroperitoneal psoas (9), thoracic-aortic-myocardial (9), epidural (7), renal (3), subphrenic (2), perinephric (2), tubo-ovarian (2), suprasternal (1), adrenal (1), and prostatic (1) abscesses (number of cases in paren- theses). Diabetes is recognized in many of these cases and probably represents a predisposing factor for inva- sive disease. Mortality is rarely reported and in almost all cases the etiology is unclear. In this case, UTI appeared to be the underlying cause of the atypical abscess in a patient who had no apparent risk factors aside from the unrecognized diabetes. There was no evidence of bladder perforation and management in- cluding abscess drainage was successful. This case is of interest for several reasons: first, most intra-abdominal abscesses are polymicrobial in nature, and secondary abscesses are a rare form of invasive GBS infection in adults. Second, although cases of secondary bacterial abscess have been associated with bacteremia, primary suppuration, and sources of occult infection, no prior case reports have associated an abdominopelvic ab- scess with a preceding acute UTI. Although the cause of the abdominopelvic abscess in this case is most probably the patient’s UTI, an unidentified gynecologic infection, or potentially undetected bacteremia related to urosep- sis, are also possible. There was no evidence of diverticu- litis or bladder diverticula. Other etiologies of secondary abscess include appendicitis, ulcerative colitis, osteomye- litis, neoplasm, discitis, and trauma, none of which were noted in this patient. A limitation of the present study was that the GBS isolate cultured from the abdomino- pelvic abscess fluid was not retained after the diagnosis. Thus, a comparative molecular analysis, which is useful as a tool for identifying clonal relationships between GBS and could have defined the degree of relatedness of the two isolates cultured from the patient in this case, was not possible. In this regard, it is important to under- score the fact that we were unable to confirm with cer- tainty the possibility that the UTI was the primary source of the abdominopelvic abscess in this patient. Several recent reports have identified aspects of the pathogenesis of acute UTI mediated by GBS [16-18], al- though there is no experimental evidence reported in the literature to the best of our knowledge that has asso- ciated GBS cystitis with a secondary abscess. Finally, the antibiotic susceptibility profile of an inter- mediate phenotype for clindamycin and erythromycin noted in this case is atypical for GBS. GBS is sensitive to penicillin and its derivatives although it may be resistant to antibiotics used for empiric treatment of UTI such as