Necrotizing Fasciitis Caused by Serotype 7C Streptococcus pneumoniae in Overwhelming Post-splenectomy Infection

Overwhelming post-splenectomy infection (OPSI) is a life-threatening condition typically caused by Streptococcus pneumoniae. Necrotizing fasciitis (NF) is a rare manifestation of invasive pneumococcal disease. A 73-year-old woman with a history of living-donor liver transplantation and splenectomy for primary biliary cholangitis presented with bilateral leg swelling, pain and altered consciousness. S. pneumoniae serotype 7C, sequence type 2758, was isolated from the blood and wound cultures. Despite intensive care and surgery, the patient developed liver graft failure and died on day 42. The emergence of non-vaccine serotypes highlights the urgent need for next-generation vaccines that target emerging strains.