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Updated: Jan 25, 2026
Capsular Serotyping of Streptococcus pneumoniae by Latex Agglutination
Published on: September 25, 2014
Necrotizing fasciitis and meningitis due to Streptococcus pneumoniae serotype 9 N: a case report
Nichlas Hovmand1, Sarah Byberg2, Morten Bo Larsen3
1Department of Infectious Diseases, Copenhagen University Hospital, Hvidovre, Denmark. nichlashovmand@me.com.
Background:
Necrotizing fasciitis is a deep infection of the fascia and subcutaneous tissue with a high mortality rate. Meningitis is an infection of the membranes surrounding the brain with a likewise high mortality rate. Streptococcus pneumoniae is the most frequent cause of bacterial meningitis and it is an extremely rare cause of necrotizing fasciitis. Different subcapsular serotypes of S. pneumoniae are known to have diverse virulence. The serotype 9 N is associated with a high risk of death.
Case Presentation:
We report a case of a previously healthy 68-year-old female who presented at our clinic with complaints of pain in her left calf since having experienced a very painful leg cramp 3 weeks prior. Within a few hours after admission, she developed fever, neck stiffness and an altered mental state. Concurrently, the pain in her leg worsened. Upon further examination it was found that she suffered from both meningitis and necrotizing fasciitis due to S. pneumoniae, serotype 9 N. The patient survived and avoided leg amputation.
Conclusions:
The patient suffered from two very lethal infections simultaneously. Both of them were caused by S. pneumoniae. We believe that her favorable outcome was, a result of prompt surgical intervention and appropriate antibiotic treatment. Our case underlines the importance of continuous reevaluation of the symptoms and clinical findings in patients with unclear causes of severe illness, especially if the patient's condition changes.
Insights
A rare case of simultaneous Streptococcus pneumoniae meningitis and necrotizing fasciitis in a 68-year-old woman highlights the importance of prompt intervention. Early diagnosis and treatment led to survival and limb preservation.
Area of Science:
- Infectious Diseases
- Bacteriology
- Critical Care Medicine
Background:
- Necrotizing fasciitis and meningitis are severe infections with high mortality rates.
- Streptococcus pneumoniae is a common cause of meningitis but a rare cause of necrotizing fasciitis.
- Serotype 9N of S. pneumoniae is linked to increased mortality risk.
Observation:
- A previously healthy 68-year-old female presented with leg pain, rapidly progressing to fever, neck stiffness, and altered mental state.
- The patient was diagnosed with concurrent meningitis and necrotizing fasciitis caused by Streptococcus pneumoniae serotype 9N.
- The patient survived the dual infection and avoided lower limb amputation.
Findings:
- Simultaneous occurrence of S. pneumoniae meningitis and necrotizing fasciitis is exceptionally rare.
- Prompt surgical intervention and appropriate antibiotic therapy were critical for patient survival.
- The specific serotype 9N of S. pneumoniae was identified as the causative agent.
Implications:
- This case underscores the need for vigilant reassessment of clinical symptoms in critically ill patients with ambiguous presentations.
- Early recognition and aggressive management are crucial for favorable outcomes in patients with multiple severe infections.
- Highlights the diverse and severe clinical manifestations of Streptococcus pneumoniae infections.
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