What question did this study set out to answer?

To highlight a case of invasive pneumococcal disease presenting as pyogenic spondylitis in a vaccinated hemodialysis patient.

February 14, 2026Internal Medicine0 citationsOpen Access

Invasive Pneumococcal Disease Presenting with Pyogenic Spondylitis in a Patient on Chronic Hemodialysis Who Previously Received a Pneumococcal Vaccine: A Case Report

MAMari ArakawaSt. Marianna University School of Medicine YFYoko FujitaSt. Marianna University School of Medicine YYYuki YokokawaKawasaki Municipal Hospital

Key Points

To highlight a case of invasive pneumococcal disease presenting as pyogenic spondylitis in a vaccinated hemodialysis patient.
Case report of a woman on chronic hemodialysis.
Assessment of clinical symptoms and routine hemodialysis.
Blood cultures and MRI were performed to confirm diagnosis.
Outpatient treatment involved intravenous ceftriaxone for six weeks.
Patient diagnosed with cervical pyogenic spondylitis from non-vaccine serotype S. pneumoniae.
MRI showed C4-C5 marrow edema and endplate destruction.
Six weeks of treatment led to clinical resolution.

Abstract

We herein report a case of cervical pyogenic spondylitis caused by Streptococcus pneumoniae in a woman on chronic hemodialysis who had received pneumococcal polysaccharide vaccine 23. The patient presented for routine hemodialysis with a fever but without focal signs. Blood cultures revealed S. pneumoniae (serotype 38, non-vaccine serotype type). Cervical magnetic resonance imaging showed C4-C5 marrow edema and endplate destruction. After brief empiric piperacillin-tazobactam, outpatient treatment comprising outpatient parenteral antimicrobial therapy with ceftriaxone was continued for six weeks, resulting in clinical resolution. Nonvaccine serotype invasive pneumococcal disease can cause spondylitis despite vaccination. Magnetic resonance imaging should be performed for similar patients to avoid neurological complications.

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