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Cellulitis due to Streptococcus pneumoniae: case report and review
M T Lawlor1, H M Crowe, R Quintiliani
1Division of Infectious Diseases, Hartford Hospital, Connecticut 06115.
Abstract:
Although Streptococcus pneumoniae remains the most common cause of community-acquired bacterial pneumonia, its involvement in skin infection is notably infrequent. A review of the literature uncovered only 13 cases of pneumococcal cellulitis in adults. Distinguishing features of skin infection by S. pneumoniae included the presence of bullae, brawny erythema, and a violaceous hue in the affected skin area. Most patients with pneumococcal cellulitis had chronic illnesses or were immunocompromised because of drug or alcohol abuse. Even with appropriate antimicrobial therapy, many patients required prolonged hospitalizations and surgery for cure. We report a case of primary pneumococcal cellulitis with secondary bacteremia in an alcoholic patient who required extensive surgical therapy and whose course was additionally complicated by acute glomerulonephritis.
Insights
Streptococcus pneumoniae rarely causes skin infections like cellulitis, often seen in immunocompromised individuals. Treatment may require prolonged hospitalization and surgery.
Area of Science:
- Infectious Diseases
- Dermatology
- Microbiology
Background:
- Streptococcus pneumoniae is a leading cause of bacterial pneumonia.
- Pneumococcal skin infections are rare, with only 13 adult cases documented in literature.
- Understanding atypical presentations of S. pneumoniae is crucial for effective treatment.
Observation:
- Pneumococcal cellulitis presents with distinct features: bullae, brawny erythema, and violaceous skin.
- Patients often have comorbidities like chronic illnesses or are immunocompromised due to substance abuse.
- This case highlights primary pneumococcal cellulitis with secondary bacteremia.
Findings:
- The patient, an alcoholic, developed severe cellulitis and bacteremia.
- Despite antimicrobial therapy, prolonged hospitalization and extensive surgery were necessary.
- Acute glomerulonephritis complicated the patient's clinical course.
Implications:
- This case underscores the importance of considering S. pneumoniae in severe, atypical cellulitis, especially in at-risk populations.
- Early recognition and aggressive management, including surgical intervention, are vital for favorable outcomes.
- Further research into pneumococcal skin tropism and host factors is warranted.