Neonatal early-onset sepsis caused by Streptococcus Gallolyticus subsp. Pasteurianus with severe pulmonary hypertension and leukemoid reaction: a case report.

BACKGROUND: Streptococcus gallolyticus subsp. pasteurianus (SGSP) is an uncommon cause of neonatal early-onset sepsis (EOS). We present a case of neonatal EOS attributed to SGSP in an infant complicated by meconium aspiration syndrome (MAS) and congenital pneumonia. The infant developed severe pulmonary hypertension and exhibited a leukemoid reaction during recovery. The clinical features of this case are rare, and a comprehensive review of her peripartum and follow-up data could enhance our understanding of this organism.

CASE PRESENTATION: This is a full-term female neonate born to a healthy mother via cesarean section due to suspected fetal distress with meconium-stained amniotic fluid. She required resuscitation in the delivery room and was subsequently admitted to the neonatal intensive care unit for respiratory distress. Both the mother and the baby exhibited fever after delivery, and cultures from the baby's blood and amniotic fluid revealed the same strain of SGSP. The baby had MAS and developed severe pulmonary hypertension, which was successfully treated with a comprehensive approach that included ampicillin, high-frequency oscillatory ventilation, inhaled nitric oxide, fluid resuscitation, and vasopressors. A significant increase in the white blood cell count was noted during her clinical improvement, followed by a spontaneous decline. The baby completed a 12-day course of ampicillin and was followed up to 1 year of age, during which she thrived. A systematic literature review on early-onset SGSP sepsis was also conducted.

CONCLUSION: SGSP infection can be associated with life-threatening complications. This case underscores the importance of considering SGSP as a potential etiology in neonatal EOS.