title: Streptococcus pneumoniae sepsis as the initial presentation of systemic lupus erythematosus.
abstract: OBJECTIVE
  Infections are among the most important causes of morbidity and mortality in patients with systemic lupus erythematosus (SLE) but are rare initial presentation of the disease. Therefore, in this study, we describe a case of Streptococcus pneumoniae sepsis in a young woman with previously undiagnosed SLE.
  
  
  METHODS
  A 23-year-old female patient was admitted to our outpatient clinic complaining of high fever (40°C), chills, fatigue, generalized myalgia, and cough with brown sputum for 5 days. Blood cultures grew gram-positive coccus defined as S. pneumoniae using standard procedures. Antinuclear antibody was positive at a titer of 1/1,000, and anti-double-stranded DNA was positive at 984 IU/mL. She was diagnosed with SLE. Her respiratory symptoms and pleural effusion were considered to be due to pulmonary manifestation of SLE.
  
  
  CONCLUSIONS
  The underlying immunosuppression caused by SLE could have predisposed the patient to invasive pneumococcal disease. It may also occur as a primary presenting feature, although a rare condition.
authors.affiliation: Department of Infectious Diseases.
authors.forename: Ilknur
authors.initials: I
authors.lastname: Erdem
authors.affiliation: Department of Infectious Diseases.
authors.forename: Senay
authors.initials: S
authors.lastname: Elbasan Omar
authors.affiliation: Department of Infectious Diseases.
authors.forename: Ridvan Kara
authors.initials: RK
authors.lastname: Ali
authors.affiliation: Department of Medical Microbiology, Faculty of Medicine, Namik Kemal University, Tekirdag, Turkey.
authors.forename: Hayati
authors.initials: H
authors.lastname: Gunes
authors.affiliation: Department of Medical Microbiology, Faculty of Medicine, Namik Kemal University, Tekirdag, Turkey.
authors.forename: Aynur Eren
authors.initials: AE
authors.lastname: Topkaya
keywords: Streptococcus pneumoniae; sepsis; systemic lupus erythematosus