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Invasive pneumococcal disease: a diagnostic challenge due to multiple portals of causative bacteria
  1. Yoshinori Tokushima,
  2. Masaki Tago,
  3. Midori Tokushima and
  4. Shu-ichi Yamashita
  1. Department of General Medicine, Saga University Hospital, Saga, Japan
  1. Correspondence to Dr Masaki Tago; tagomas{at}


A 64-year-old woman was transferred to our hospital because of fever, painful swelling in upper jaw, back pain and dysuria. She was in shock and physical examinations revealed tenderness on maxillary sinus, cellulitis in the right foot, hypoesthesia in both lower extremities and groin, mild weakness in both lower extremities, and bladder and rectal dysfunctions. Blood examination showed elevated white cell count and C reactive protein, and urinalysis revealed urinary tract infection. Spinal MRI detected spondylodiscitis with epidural abscess. After detection of Streptococcus pneumoniae by cultures of blood and fluid from lumbar abscess, she was consequently diagnosed with invasive pneumococcal disease likely secondary to acute exacerbation of chronic sinusitis. Pyogenic spondylitis or epidural abscess is a rare but serious complication of invasive pneumococcal disease. Furthermore, S. pneumoniae should be suspected as a causative organism when seeing a patient with severe infectious diseases complicated with sinusitis.

  • ear, nose and throat/otolaryngology
  • infectious diseases
  • urinary tract infections

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  • YT and MT contributed equally.

  • Contributors YT and MTag were involved in concept, literature search and drafting. MTok was involved in literature search and drafting. SY was involved in revision of article.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Disclaimer Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.