title: Rapidly progressive fatal pneumococcal sepsis in adults: a report of two cases.
abstract: We report two cases of a rapidly progressive fatal overwhelming pneumococcal infection. Patient 1 was a 67-year-old man with a 24-h history of fever and malaise and was transferred to our department. He was severely ill, tachypneic, and felt a chill. A purpuric discoloration with ecchymosis of the skin was noted over the body. The chest X-ray findings demonstrated thickening of the bronchovascular bundle in the right lower lung field, which later revealed the presence of bronchopneumonia. Laboratory studies revealed the presence of metabolic acidosis and disseminated intravascular coagulation. After presentation, rapid deterioration occurred followed by cardiopulmonary arrest. Despite cardiopulmonary resuscitation, the patient died only 3 h after presentation. The isolates from the patient's blood revealed penicillin-susceptible Streptococcus pneumoniae, serotype 4. Patient 2 was a 30-year-old woman with a prior history of uneventful pregnancies was transferred to our department with a 2-day history of fever, nausea, headache, and malaise. Although she was in the 19th week of pregnancy at the time, she suffered a miscarriage just prior to admission. Upon presentation to our department, she demonstrated unstable vital signs, diminished consciousness, anuria, and icterus. Purpuric discoloration with ecchymosis of the skin was noted in over most of her body, including the distal extremities. The chest X-ray findings were close to normal. Initial laboratory studies revealed the presence of severe metabolic acidosis and disseminated intravascular coagulation with multiple organ failure. Despite aggressive cardiopulmonary support, normal neurological responses disappeared on the 2nd day following admission and the patient died on the 16th day after admission. The patient's isolates from blood and vaginal swabs both later revealed penicillin-susceptible Streptococcus pneumoniae, serotype 12F. The presentation of rapidly progressive septic shock should raise the treating physician's suspicion of overwhelming pneumococcal infection, which has limited management options.
authors.affiliation: Emergency and Critical Care Medical Center, Niigata City General Hospital, Shichikuyama 2-6-1, Chuouku, Niigata City, Niigata 950-8739, Japan. iinuma@hosp.niigata.niigata.jp
authors.forename: Yasushi
authors.initials: Y
authors.lastname: Iinuma
authors.forename: Yasuo
authors.initials: Y
authors.lastname: Hirose
authors.forename: Toshiharu
authors.initials: T
authors.lastname: Tanaka
authors.forename: Ken
authors.initials: K
authors.lastname: Kumagai
authors.forename: Mamoru
authors.initials: M
authors.lastname: Miyajima
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Sekiguchi
authors.forename: Yuji
authors.initials: Y
authors.lastname: Nomoto
authors.forename: Masahiro
authors.initials: M
authors.lastname: Yabe
authors.forename: Yumiko
authors.initials: Y
authors.lastname: Imai
authors.forename: Yoshihiko
authors.initials: Y
authors.lastname: Yamazaki
mesh_terms: D000328:Adult; D000368:Aged; D016470:Bacteremia / Q000382:microbiology*; D017809:Fatal Outcome; D005260:Female; D006801:Humans; D008297:Male; D011008:Pneumococcal Infections / Q000175:diagnosis* / Q000382:microbiology; D011018:Pneumonia, Pneumococcal / Q000175:diagnosis / Q000382:microbiology; D011247:Pregnancy; D013296:Streptococcus pneumoniae / Q000302:isolation & purification*