DISCUSSION
As described previously, cutaneous manifestations of Group Cstreptococcus (GCS) are fairly uncommon in the clinical setting, however not unheard of. GCS bacteremia that are associated with cutaneous eruptions have been described in past literature.5,8 GCS in and of itself as an isolated finding on blood culture, is fairly rare and generally encountered in individuals with comorbidities such as immunosuppression or malignancy. In the context of an otherwise healthy female patient, the incidence of cutaneous lesions of Group C bacteremia are exceedingly rare.Strep dysgalactiae is a member of the group C Strep family. It is a gram-positive coccus that is in a chain configuration and beta hemolytic.3 Strep dysgalactiae is a commensal bacteria that is found mostly in the alimentary tract or genital tract, but can occasionally be found on skin as a component of the skin flora. Initially, this group of strep was thought to be non-pathogenic in humans, however, recent findings have shown that some skin and tonsillar infections are a result of Strep dysgalactiaecolonization.3 It is postulated that strep dysgalactiae can be responsible for some cellulitis cases.4,7 Aside from local cellulitis or erysipelas, other cutaneous manifestations can be seen in the context of a systemic bacteremia.4 In literature, rare cases of Strep dysgalactiae bacteremia can present with a diffuse papular rash that can expand to the trunk and extremities. Cases of necrotizing fasciitis are also attributed to Strep dysgalactiae . This case report presents a patient with Strep dysgalactiae bacteremia associated with tender macular exanthem on bilaterally upper and lower extremities and trunk, myalgias and weakness. This is a fairly rare presentation of GCS bacteremia than what is often seen clinically. Generally, Group C strep bacteremia presents as a profound sepsis or meningitis with resultant positive blood cultures. 6 In this case, the patient had no findings significant for meningitis. The patient presented with significant systemic findings of fever, myalgia, arthralgia, elevated LFTs, sepsis and thrombocytopenia with diffusely tender exanthem. There are very few case presentations on Group C strep bacteremia with diffuse myalgias and associated cutaneous manifestations. The resolution of the rash and pain with antibiotics therapy and negative re-growth of Strep dysgalactiae on blood culture indicated an infectious process, thus supporting our rare case presentation. In addition to the atypical presentation of Group C strep which is very sparsely described in literature, our patient’s dermatological findings were also distinct from the prior accounts ofStrep dysgalactiae associated cutaneous lesions. This case corroborates the current emphasis toward Strep dysgalactiae as a pathogen of increasing suspicion when faced with variable clinical presentations.