Journal of General Internal Medicine

, Volume 34, Issue 8, pp 1653–1657 | Cite as

Pneumococcal Bacteremia Complicated by Hemophagocytic Lymphohistiocytosis

  • Frederick HowardEmail author
  • Christopher Sankey
Clinical Practice: Clinical Vignettes


From pneumonia to pericarditis, from sepsis to splenic abscess, Streptococcus pneumoniae is the causative agent of a diverse array of pyogenic disease. With the introduction of vaccines and effective antibiotic treatments, the incidence of complicated streptococcal infection has declined. We report a case of S. pneumoniae bacteremia, in the setting of occult sinusitis, complicated by hemophagocytic lymphohistiocytosis (HLH), disseminated intravascular coagulation (DIC), and recurrent pneumococcal infection. Although severe streptococcal infection has been associated with immunodeficiency or splenectomy, no such predisposition was identified in our patient. We discuss the association of streptococcal infection with HLH and DIC and review occult sinusitis as a source of pneumococcal bacteremia, with the goal of enhancing the “illness scripts” of general medical practitioners to include such entities.


pneumococcus Streptococcus pneumoniae bacteremia hemophagocytic lymphohistiocytosis sinusitis 


Compliance with Ethical Standards

Conflict of Interest

The authors declare that they do not have a conflict of interest.


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Copyright information

© Society of General Internal Medicine 2019

Authors and Affiliations

  1. 1.Department of Internal MedicineYale School of MedicineNew HavenUSA
  2. 2.Yale New Haven HospitalNew HavenUSA

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