This little girl was born at 32 weeks' gestation by emergency caesarean section for pregnancy‐induced hypertension and fetal distress. Initial course of penicillin and gentamicin were discontinued at 36 h, when her blood culture done at birth was found to be negative.
On day 20 she deteriorated with bradycardias and desaturations, and she was noticed to have an erythematous, warm, firm swelling in the right submandibular region, extending from her right ear to the upper neck. (fig 1). The rest of her clinical examination was unremarkable. She was ventilated for apnoea. Her blood culture grew group B streptococcus (GBS) after 12 h. An ultrasound examination revealed multiple right submandibular lymphnodes with subcutaneous tissue thickening. She made an uneventful recovery after treatment with broad spectrum antibiotics. Her surface swabs were negative and maternal group B status was unknown.
Figure 1 Erythema and swelling with central clearing in the right submandibular region. Informed parental consent was obtained for publication of this figure.
Cellulitis‐adenitis is a rare presentation of GBS infection in neonates. The clinical features include a mean age at onset of 5 weeks, male predominance (75%), and rapid resolution with appropriate antimicrobial therapy. It is usually GBS type III and the pathogenesis is postulated to be lymphatic spread from ipsilateral otitis media or mucus membrane colonization with subsequent bacteremia and seeding of the soft tissues.1,2
References
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