Rare case of Streptococcal enteritis in HIV patient

Abstract

Only a small number of cases of Streptococcus pneumoniae bacteremia with gastrointestinal tract involvement have been reported in the literature, even in immunocompromised patients. This case report describes an immunosuppressed forty-year old human immunodeficiency virus (HIV)-positive patient with S. pneumoniae bacteremia presenting as acute enteritis. The patient suffered from fever, severe watery diarrhea, and acute abdomen. Laboratory tests showed elevation of inflammatory markers and acute kidney injury. Stool examination was positive for fecal leucocytes, while radiology studies were indicative of respiratory involvement. The patient was rehydrated and initially treated with IV ciproflocaxin and metronidazole, but after positive blood culture result for S. pneumoniae, the treatment was changed to IV ceftriaxone. The patient responded to the treatment and was discharged on 7th day with oral moxifloxacin prescribed. Ten days after finishing the treatment, there was a lower respiratory tract recurrence with negative blood cultures for S. pneumoniae, which responded to meropenem without another recurrence until today. In the last 26 years (1993-2019), a few cases have been described, two of which in HIV-positive patients. To our knowledge, this is the first case of concurrent severe S. pneumoniae pneumonia and enteritis without any complaints from the respiratory system in a severely immunosuppressed patient.