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Invasive Pneumococcal Disease ( Ipd )

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Invasive pneumococcal disease (IPD) is defined as the recovery of an isolate of S. pneumoniae from a normally sterile site, such as blood, cerebrospinal fluid (CSF), pleural fluid, joint aspirate, pericardial fluid, or peritoneal fluid [1]. Splenic abscesses are rare in the pediatric population [2]. Early recognition and intervention are critical due to the high mortality rate associated with delayed diagnosis [3]. A literature review revealed no case reports of splenic abscesses due to invasive pneumococcal disease (IPD). Purpura fulminans is a rare complication of IPD. We report a case of IPD confirmed by blood culture and serotyping in a 15 month old African American female whose clinical coursewas complicated by splenic abscesses and …show more content…

Laboratory investigations revealed a pH of 7.1, PCO2 of 35mmHg, PO2 of 52mmHg, HCO3 of 11mg/dl, prothrombin time of 37.8 seconds, international normalized ratio (INR) of 3.8, activated partial prothrombin time of 101.4 seconds, total leukocyte count of 1900/mm3 with 10% banded neutrophils and 25% segmented neutrophils, hemoglobin of 10.8g/dl and platelet count of 67,000/mm3. Lumbar puncture was performed and revealed a white blood cell count of 1 per mm3, red blood cell count of 3 per mm3, glucose of 108mg/dl and protein 83mg/dl. Blood, urine and cerebrospinal fluid (CSF) cultures were sent and she was started on broad spectrum antibiotics with vancomycin and ceftriaxone.
She was admitted to the pediatric intensive care unit (PICU) for management of septic shock, disseminated intravascular coagulopathy and multiple organ dysfunction syndrome. Blood culture grew Streptococcus pneumoniae that was sensitive to penicillin and ceftriaxone with a minimum inhibitory concentration (MIC) of less than 0.03 mcg/ml. She was initially hypotensive despite being placed on vasoactive medications for treatment of refractory shock. During her PICU course, it was she was noted to develop dry gangrene of the distal phalanges on her upper (Figure 1A) and lower extremities (Figure 1B), which were consistent with purpura fulminans. She remained febrile after resolution of septic shock. A computerized tomography (CT) scan of abdomen with contrast revealed 3 rim-enhancing

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