Pneumococcal Soft-Tissue Infections: A Problem Deserving More Recognition

Abstract

Streptococcus pneumoniae is an uncommonly recognized etiology of soft-tissue infections. Our experience suggests that pneumococci can cause serious infections of soft tissues, especially in patients with connective-tissue diseases. Systemic lupus erythematosus was an underlying condition in three of the six patients described in the present report.

Fcγriia polymorphism as a risk factor for invasive pneumococcal infections in systemic lupus erythematosus

“…In a report of the National Institutes of Health cohort of 467 SLE patients, 9 individuals (1.9%) were identified as having had extrapulmonary or invasive pneumococcal infections (1). A variety of invasive pneumococcal infections in SLE patients has been previously reported, including bacteremia, spontaneous peritonitis, epiglottitis, cellulitis, and fasciitis (1)(2)(3)(4).…”

“…None were taking cytotoxic agents, and the maximum daily dose of prednisone was 15 mg. Many of the soft tissue pneumococcal infections in SLE reported by DiNubile and colleagues (3,4) occurred in the setting of little or no corticosteroid therapy. Thus, while the effects of corticosteroids can not be discounted, low doses probably do not have strong inhibitory effects on phagocyte function in SLE (12).…”

Rare Presentation of Streptococcus pneumoniae Pneumonia with Bacteremia and Multiple Subcutaneous Abscesses

“…Although bacteremia can lead to suppurative complications such as meningitis, pericarditis, arthritis, and osteomyelitis, metastatic infections in soft tissue are fairly uncommon [1]. In fact, most reported cases of Streptococcus pneumoniae soft tissue infection have involved cellulitis that arose by direct inoculation from trauma rather than bacteremic spread [2,3]. A case of pneumococcal pneumonia with bacteremia is reported in which the patient sought medical attention because of painful subcutaneous abscesses.…”

Necrotizing fasciitis caused by Streptococcus pneumoniae in mixed connective tissue disease

“…To our knowledge, only five cases of necrotizing fasciitis due to S. pneumoniae have been reported. [2][3][4][5] Interestingly, three of these five cases developed in patients with systemic lupus erythematosus (SLE). Connective tissue diseases, especially SLE, have been recognized as a risk factor for severe pneumococcal infections such as pneumonia, septicemia, and soft-tissue infections.…”