Invasive Pneumococcal Disease Presenting with Pyogenic Spondylitis in a Patient on Chronic Hemodialysis Who Previously Received a Pneumococcal Vaccine.
Mari Arakawa, Yoko Fujita, Yuki Yokokawa et al.
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Case in brief
A woman receiving chronic hemodialysis presented with fever during a routine session, without focal signs. Blood cultures grew Streptococcus pneumoniae serotype 38, a non-vaccine serotype, despite prior pneumococcal polysaccharide vaccine 23. Cervical MRI demonstrated C4–C5 marrow edema and endplate destruction, consistent with pyogenic spondylitis. Following brief empiric piperacillin-tazobactam, she received outpatient parenteral ceftriaxone for six weeks, with clinical resolution.
What made this case unusual
Cervical pneumococcal spondylitis occurred in a previously vaccinated patient and was caused by serotype 38, which the report identifies as a non-vaccine serotype.
Diagnostic / clinical pearl
In a patient on hemodialysis with pneumococcal bacteremia, spondylitis may be present even without focal signs; cervical MRI can identify spinal infection and help avoid neurological complications.