Necrotizing Fasciitis Caused by Serotype 7C Streptococcus pneumoniae in Overwhelming Post-splenectomy Infection

Area of Science:

• Infectious Diseases
• Transplantation Medicine
• Microbiology

Background:

• Overwhelming post-splenectomy infection (OPSI) is a severe complication, often caused by Streptococcus pneumoniae.
• Necrotizing fasciitis (NF) is a rare but devastating manifestation of invasive pneumococcal disease.
• Patients with a history of splenectomy, particularly those who have undergone organ transplantation, are at increased risk.

Purpose of the Study:

• To report a rare case of necrotizing fasciitis secondary to Streptococcus pneumoniae in a liver transplant recipient with splenectomy.
• To highlight the clinical presentation, causative agent, and outcome of this severe infection.
• To emphasize the limitations of current vaccines against emerging pneumococcal serotypes.

Main Methods:

• Case report of a 73-year-old female liver transplant recipient with splenectomy.
• Clinical presentation: bilateral leg swelling, pain, and altered consciousness.
• Microbiological analysis: isolation of Streptococcus pneumoniae serotype 7C (ST 2758) from blood and wound cultures.

Main Results:

• The patient presented with symptoms consistent with severe invasive pneumococcal disease.
• Despite intensive care and surgical intervention, the patient experienced liver graft failure.
• The patient succumbed to the infection 42 days after admission.

Conclusions:

• This case illustrates a rare presentation of invasive pneumococcal disease with necrotizing fasciitis in an asplenic liver transplant recipient.
• The isolation of a non-vaccine serotype (7C) highlights the evolving landscape of pneumococcal pathogens.
• There is a critical need for next-generation pneumococcal vaccines effective against emerging and non-vaccine serotypes to prevent OPSI.