Key clinical message:
S. intermedius has a unique tropism in the brain, liver, and lungs leading to abscess formation. When compared to other members of this group like Streptococcus anginosus and Streptococcus constellatus, S. intermedius infections are more substantial. S. intermedius is unique to the other bacteria in SAG due to the expression of intermedilysin (ILY), allowing it to cause cell necrosis with membrane bleb formation. The mortality rate for SAG-associated bacteremia is 10-16%. Early recognition and timely intervention are important for successful treatment and improved outcomes. There are currently no screening guidelines when S. intermedius is found in culture data however clinicians should have a low threshold to consider imaging for indolent infections.