Pneumococcal Bacteremia Complicated by Hemophagocytic Lymphohistiocytosis

Abstract

From pneumonia to pericarditis, from sepsis to splenic abscess, Streptococcus pneumoniae is the causative agent of a diverse array of pyogenic disease. With the introduction of vaccines and effective antibiotic treatments, the incidence of complicated streptococcal infection has declined. We report a case of S. pneumoniae bacteremia, in the setting of occult sinusitis, complicated by hemophagocytic lymphohistiocytosis (HLH), disseminated intravascular coagulation (DIC), and recurrent pneumococcal infection. Although severe streptococcal infection has been associated with immunodeficiency or splenectomy, no such predisposition was identified in our patient. We discuss the association of streptococcal infection with HLH and DIC and review occult sinusitis as a source of pneumococcal bacteremia, with the goal of enhancing the Billness scripts^of general medical practitioners to include such entities.

A rare case of streptococcal pharyngitis in an adult male causing hemophagocytic lymphohistiocytosis

“…Complications due to Streptococcus pneumoniae bacteremia were also seen in a 46-year-old Filipino male, who had come with complaints of unresolved fever and multiple joint pains and was investigated to have elevated inflammatory markers and HLH. He responded well to a 2-week course of ceftriaxone and a 5-week course of dexamethasone [13]. This case is unique due to Streptococcus pharyngitis which appears rarely in an adult and rarely can cause a life-threatening syndrome like HLH.…”