Recurrent Pneumococcal bacteraemia and meningitis in an asplenic adult with possible unusual focus

An unusual case of a dental infection leading to osteitis of the mandible and possibly to 4 episodes of invasive pneumococcal disease in an asplenic adult is presented. The patient had 2 episodes of pneumococcal meningitis with bacteraemia and 2 episodes of bacteraemia without meningitis during a 1-y period. Investigations using bone and leukocyte scintigraphy revealed only a focal uptake in the right mandibular bone. The pneumococcal strains isolated during the 4 episodes were all serotype 23F, and fully susceptible to penicillin.