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

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.