Correct!
3. Streptococcus agalactiae
The patient presents with a history of splenectomy, making encapsulated organisms the most likely causative organism. Streptococcus agalactiae or Group B Streptococcus (GBS) is a gram positive encapsulated organism that has been documented to present with hypotension, coagulopathy, renal dysfunction, and erythematous rash (2). Streptococcus pneumoniae is unlikely given negative clinical history without notable findings on CT imaging, and negative streptococcal antigen. Neisseria meningitidis is unlikely given no sign of meningismus and a lumbar puncture with low cell count and normal glucose levels. Haemophilus influenzae is a gram-negative bacteria.
The resident astutely notes that a finger is necrotic distally (Figure 2).
Figure 2. Photograph of patient’s necrotic finger.
On further examination, the patient’s toes are also necrotic.
What therapy would you initiate? (Click on the correct answer to proceed to the fourth of five pages)