Streptococcus intermedius lung abscess in children: a case report and literature review.

Streptococcus intermedius is a gram-positive commensal associated with suppurative infections. Pediatric pulmonary abscesses due to S. intermedius are rare, and outcomes in children with severe neurological comorbidities are poorly characterized. A 5-year-old boy with refractory epilepsy and global developmental delay who presented with a right upper lobe abscess, pneumonitis, and pleural effusion. Targeted next-generation sequencing (tNGS) of bronchoalveolar lavage fluid (BALF), drainage pus culture, and tNGS of drainage pus all confirmed the presence of S. intermedius. To our knowledge, this is the first reported case of a residual pulmonary cavity on 3-month follow-up imaging after an S. intermedius lung abscess in a child with severe neurological impairment. Our findings highlight the value of tNGS in diagnosing lower respiratory tract infections caused by pathogens that are difficult to identify through conventional culture methods.