[Pneumococcal pneumonia with a fulminant course]

Four patients admitted with a pneumococcal pneumonia are described. Well-known risk factors such as immunodeficiency or preexisting cardiopulmonary problems were absent. They had been ill for three to five days and had not been treated with antibiotics. Three patients died; upon admission these had extensive pulmonary infiltrates (two or more lobes affected), respiratory insufficiency necessitating mechanical ventilation, and shock at or soon after admission. The prognosis of pneumococcal pneumonia with a fulminant course has not improved in the last few decades despite proper antibiotics and intensive care treatment. Mortality is over fifty percent. Early recognition and treatment can contribute to a better prognosis.