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Case Report

Meningitis, Spondylodiscitis, Pneumonia and Septic Shock with Streptococcus pneumoniae in a Previously Healthy Woman with Isolated IgG2-, IgG3-, IgA-Deficiency and Monoclonal Gammopathy of Undetermined Significance

by
Shahin Gaini
1,2,3,*,
David Gudnason
1,
Bjarni á Steig
4 and
Jenny Jónsdóttir Nielsen
1
1
Department of Medicine, Infectious Diseases Division, National Hospital Faroe Islands, Tórshavn, Faroe Islands
2
Infectious Diseases Research Unit, Odense University Hospital and University of Southern Denmark, Odense, Denmark
3
Department of Science and Technology, University of the Faroe Islands, Tórshavn, Faroe Islands
4
Department of Medicine, Hematology Division, National Hospital Faroe Islands, Tórshavn, Faroe Islands
*
Author to whom correspondence should be addressed.
Infect. Dis. Rep. 2018, 10(1), 7310; https://doi.org/10.4081/idr.2018.7310
Submission received: 12 July 2017 / Revised: 13 September 2017 / Accepted: 6 November 2017 / Published: 29 March 2018

Abstract

A 66 years old Caucasian woman with pneumococcal meningitis was treated and discharged after an uncomplicated course. Five months later she was readmitted withfever and right side abdominal pain and diagnosed with pneumococcal spondylodiscitis. One year later she was treated fora severe chest X-ray confirmed left lobar pneumonia. Two years later she was diagnosed with a pneumococcal pneumonia inher left lung with septic shock. An immunedeficiency screen revealed slightly reduced IgA levels, low IgG2 levels, low IgG3 levels and high IgG1 levels. No other immunedefects were identified. She did not respondserologically on vaccination with 13-valentconjugate and 23-valent polysaccharide pneumococcal vaccines. Further evaluations revealed a positive M-component inher blood and a bone marrow biopsy diagnosed her to have monoclonal gammopathy of undetermined significance. To protecther against future life threatening pneumococcal infections she was started on treatment with intravenous immunoglobulin. The case report illustrates the importance of thorough evaluation of patients with unusual infectious disease entities or unusual frequency of infections in individual patients. To optimize prophylactic measures and active treatment options in the individual patient, it is important to identify underlying causes of diseases and immune deficiencies that potentially can lead to life threatening infections. This is illustrated inour case by an undiagnosed monoclonal gammopathy of undetermined significancein an apparently healthy woman with atleast three life threatening documented pneumococcal infections in a two-year period and poor pneumococcal vaccine response
Keywords: Streptococcus pneumonia; meningitis; spondylodiscitis; pneumonia; monoclonal gammopathy of undetermined significance Streptococcus pneumonia; meningitis; spondylodiscitis; pneumonia; monoclonal gammopathy of undetermined significance

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MDPI and ACS Style

Gaini, S.; Gudnason, D.; á Steig, B.; Nielsen, J.J. Meningitis, Spondylodiscitis, Pneumonia and Septic Shock with Streptococcus pneumoniae in a Previously Healthy Woman with Isolated IgG2-, IgG3-, IgA-Deficiency and Monoclonal Gammopathy of Undetermined Significance. Infect. Dis. Rep. 2018, 10, 7310. https://doi.org/10.4081/idr.2018.7310

AMA Style

Gaini S, Gudnason D, á Steig B, Nielsen JJ. Meningitis, Spondylodiscitis, Pneumonia and Septic Shock with Streptococcus pneumoniae in a Previously Healthy Woman with Isolated IgG2-, IgG3-, IgA-Deficiency and Monoclonal Gammopathy of Undetermined Significance. Infectious Disease Reports. 2018; 10(1):7310. https://doi.org/10.4081/idr.2018.7310

Chicago/Turabian Style

Gaini, Shahin, David Gudnason, Bjarni á Steig, and Jenny Jónsdóttir Nielsen. 2018. "Meningitis, Spondylodiscitis, Pneumonia and Septic Shock with Streptococcus pneumoniae in a Previously Healthy Woman with Isolated IgG2-, IgG3-, IgA-Deficiency and Monoclonal Gammopathy of Undetermined Significance" Infectious Disease Reports 10, no. 1: 7310. https://doi.org/10.4081/idr.2018.7310

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