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Pneumococcal Bacteremia Complicated by Hemophagocytic Lymphohistiocytosis

Frederick Howard1,2, Christopher Sankey3,4

  • 1Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA. Frederick.howard@yale.edu.

Journal of General Internal Medicine
|April 24, 2019
PubMed

Insights

Streptococcus pneumoniae caused severe illness, including hemophagocytic lymphohistiocytosis (HLH) and disseminated intravascular coagulation (DIC), originating from an undetected sinus infection. This case highlights rare complications of pneumococcal bacteremia in otherwise healthy individuals.

Area of Science:

  • Infectious Diseases
  • Hematology
  • Critical Care Medicine

Background:

  • Streptococcus pneumoniae is a common cause of pyogenic infections, but severe, complicated cases are less frequent due to vaccines and antibiotics.
  • While typically associated with immunocompromise or splenectomy, severe pneumococcal infections can occur in seemingly healthy individuals.
  • Occult sinusitis can serve as a hidden reservoir for S. pneumoniae, leading to systemic infection.

Observation:

  • A case of S. pneumoniae bacteremia was identified.
  • The bacteremia was complicated by hemophagocytic lymphohistiocytosis (HLH), disseminated intravascular coagulation (DIC), and recurrent pneumococcal infections.
  • No underlying immunodeficiency or splenectomy was found in the patient.

Findings:

  • This case demonstrates a rare presentation of S. pneumoniae bacteremia originating from occult sinusitis.
  • The infection led to severe systemic complications, including HLH and DIC, in a patient without apparent predisposing factors.
  • Recurrent pneumococcal infections suggest a complex host-pathogen interaction.

Implications:

  • Enhancing medical practitioners' understanding of potential severe outcomes from S. pneumoniae, even from occult sources.
  • Recognizing the association between pneumococcal infections, HLH, and DIC is crucial for timely diagnosis and management.
  • The case underscores the importance of considering sinusitis as a potential source of recurrent or severe pneumococcal disease.
Keywords:
Streptococcus pneumoniaebacteremiahemophagocytic lymphohistiocytosispneumococcussinusitis

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