Invasive pneumococcal disease: a diagnostic challenge due to multiple portals of causative bacteria

A 64-year-old woman was transferred to our hospital because of fever, painful swelling in upper jaw, back pain and dysuria. She was in shock and physical examinations revealed tenderness on maxillary sinus, cellulitis in the right foot, hypoesthesia in both lower extremities and groin, mild weakness in both lower extremities, and bladder and rectal dysfunctions. Blood examination showed elevated white cell count and C reactive protein, and urinalysis revealed urinary tract infection. Spinal MRI detected spondylodiscitis with epidural abscess. After detection of Streptococcus pneumoniae by cultures of blood and fluid from lumbar abscess, she was consequently diagnosed with invasive pneumococcal disease likely secondary to acute exacerbation of chronic sinusitis. Pyogenic spondylitis or epidural abscess is a rare but serious complication of invasive pneumococcal disease. Furthermore, S. pneumoniae should be suspected as a causative organism when seeing a patient with severe infectious diseases complicated with sinusitis.