Invasive pneumococcal disease confirmed in five different sites including Austrian syndrome in a male patient with methamphetamine abuse

Abstract

A 60-year-old man with no significant medical history was found unresponsive by his neighbour; he had neck stiffness on physical examination in the emergency department. He later developed acute hypoxic respiratory failure requiring endotracheal intubation. He is a binge drinker on weekends, and methamphetamine was detected in his urine. Contrast-enhanced CT of the chest, abdomen and pelvis revealed multifocal pneumonia, bilateral psoas abscesses and right infraspinatus muscle abscess. Blood, sputum and cerebrospinal fluid cultures grew Streptococcus pneumoniae. Transthoracic echocardiography (TTE) revealed tricuspid endocarditis with mild valve insufficiency. He was initially treated with intravenous antibiotics and underwent incision and drainage of right psoas abscess. However, he still had recurrent fever and confusion. Repeat TTE showed larger vegetation, and he also developed septic emboli at the posterior basal right lower lobe pulmonary artery. The patient underwent tricuspid valve debridement and was finally discharged after completing 6 weeks of intravenous antibiotic treatment.

Invasive pneumococcal disease serotype 23B1 causing multifocal septic arthritis, myositis and retroperitoneal abscess

“…There are less than 20 cases of primary pneumococcal psoas abscesses2–4 and 40 cases of pneumococcal pyomyositis5 6 reported in the literature. Two-thirds of cases of pneumococcal pyomyositis were preceded by meningitis or respiratory illness and one-third of cases were preceded by muscle trauma 5.…”

“…There is a 90% success rate with non-surgical intervention and 3% overall mortality rate for psoas abscesses, making this a highly treatable condition 13. In case reports of pneumococcal psoas abscesses, treatment with prompt abscess drainage and antibiotic therapy were also associated with a favourable prognosis 2 3…”

“…The most common manifestations of IPD include bacteraemia, meningitis and endocarditis 1. Myositis, intramuscular abscesses, septic arthritis and tenosynovitis are all uncommon presentations of IPD 2–8…”