title: Streptococcus pneumoniaebacteraemia due to parotitis in a patient with systemic sclerosis and secondary Sjögren's syndrome.
abstract: BACKGROUND
  Invasive pneumococcal disease is an uncommon and notifiable disease in Singapore. It is often associated with significant morbidity and mortality. We report a rare case of invasive pneumococcal bacteraemia due to parotitis in a patient with systemic sclerosis and secondary Sjögren's syndrome. We also present a retrospective review ofStreptococcus pneumoniaebacteraemia cases in Singapore General Hospital from January 2011 to April 2016.
  
  
  METHODS
  A 59-year-old Malay lady with a history of systemic sclerosis with secondary Sjögren's syndrome presented with fever and left parotid gland swelling. Clinical examination revealed poor salivary pooling and left parotid swelling without fluctuance. Ultrasound of the left parotid gland confirmed acute parotitis without evidence of abscess or sialolithiasis. Blood cultures were positive forS. pneumoniae. She was diagnosed to have invasive pneumococcal bacteraemia secondary to acute parotitis, and treated with intravenous benzylpenicillin with clearance of bacteraemia after 3 days. Upon discharge, her antibiotics were changed to intravenous ceftriaxone to facilitate outpatient parenteral antibiotic therapy for another 2 weeks. She responded favourably to antibiotics at follow-up, with no complications from the bacteraemia. A review of the microbiological records of the Singapore General Hospital revealed 116 cases of pneumococcal bacteraemia, most (80.3 %) of which were due to pneumonia. None were due to parotitis.
  
  
  CONCLUSIONS
  S. pneumoniaeparotitis and subsequent bacteraemia is rare. Prompt recognition of the disease and appropriate use of antibiotics are important. This case highlights that close communication between healthcare workers (microbiologist, rheumatologist and infectious disease specialist) is essential in ensuring good clinical outcomes in patients with a potentially fatal disease.
authors.affiliation: Department of Rheumatology and Immunology, Singapore General Hospital , Singapore.
authors.forename: Irene Yuen Lin
authors.initials: IY
authors.lastname: Yii
authors.affiliation: Department of Pathology, Singapore General Hospital, Singapore.
authors.forename: Jamie Bee Xian
authors.initials: JB
authors.lastname: Tan
authors.affiliation: Department of Rheumatology and Immunology, Singapore General Hospital, Singapore; Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Duke-NUS Medical School, Singapore.
authors.forename: Warren Weng Seng
authors.initials: WW
authors.lastname: Fong
keywords: Sjögren’s syndrome; Streptococcus pneumoniae; parotitis; systemic sclerosis