Navigating a stealthy invader: Insights from two different Streptococcus intermedius cases

<i>Streptococcus intermedius</i>, a gram-positive, beta-hemolytic, catalase-negative member of the <i>Streptococcus milleri</i> group, is a commensal organism within the human body that is known for its propensity to cause severe bacterial infections. This case report presents two distinct cases involving culture-positive <i>S. intermedius</i> infections. The first case involves a 53-year-old man diagnosed with new liver, lung, and brain lesions in the setting of suspected renal cell carcinoma. In the second case, an 84-year-old woman was found to have <i>S. intermedius</i> bacteremia with concurrent culture-positive liver abscesses. These cases illustrate the intricate nature of <i>S. intermedius</i> infections, which may manifest with a diverse spectrum of clinically significant systemic symptoms. Presently, there are no standardized protocols for screening, and subsequently managing, <i>S. intermedius</i> infections. Since <i>S. intermedius</i> has the potential to mimic other infections or pathological conditions, it warrants space on a differential until a negative culture or PCR assay is obtained.