Streptococcus pneumoniae sepsis in concurrently diagnosed multiple myeloma Georg Aue 1 * and Thorsten Austein 2 1 Hematology Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland 2 Internal Medicine, St. Bernhard Hospital, Brake, Germany A 60-year-old female with a past medical history of osteoporosis presented to the emergency room with a chief complaint of chest pain and dyspnea. The patient was hypotensive, febrile (1038F), and required emergent intubation. Vancomycin and ceftazidime were initiated. The chest X-ray was unremarkable; however, the leuko- cyte count was 1,000 per cubic milliliter, the hemoglobin was 11.5 g/dl, and the platelet count was 76,000 per cubic milliliter. The creatinine was 2.6 g/dl, and the lactate dehy- drogenase was 650 IU/l. May-Gru ¨ nwald and Giemsa staining of the peripheral blood smear (image. 1) showed lancet-shaped cocci in pairs (arrow). The bone marrow aspirate (was image. 2, May-Gru ¨ nwald and Giemsa staining) conﬁrmed cocci with a clear zone (arrow), indicating the presence of an encapsu- lated organism, which is typical for Streptococcus pneumoniae, and revealed increased numbers of plasma cells con- sistent with multiple myeloma. The patient died 4 h after admission from multisystem organ failure. Blood cultures grew Streptococcus pneumoniae 1 day later. Image 1. Peripheral blood smear (May-Gru ¨ nwald and Giemsa staining) showed lancet-shaped cocci in pairs (arrow). Image 2. Bone marrow aspirate (May-Gru ¨ nwald and Giemsa staining) conﬁrmed cocci with a clear zone (arrow), typical for Streptococcus pneumoniae. *Correspondence to: Georg Aue, MD, Hematology Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Building 10, CRC Room 3-3216, 10 Center Drive (MSC 1202), Bethesda, MD 20892-1202. E-mail: [email protected] Received for publication 5 January 2007; Revised 15 January 2007; Accepted 18 January 2007 Am. J. Hematol. 82:858, 2007. Published online 15 May 2007 in Wiley InterScience (www.interscience. wiley.com). DOI: 10.1002/ajh.20911 Published 2007 Wiley-Liss, Inc. { This article is a US Government work and, as such, is in the public domain in the United States of America. American Journal of Hematology 858 http://www3.interscience.wiley.com/cgi-bin/jhome/35105

Streptococcus pneumoniae sepsis in concurrently diagnosed multiple myeloma

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Streptococcus pneumoniae sepsis in concurrently diagnosedmultiple myeloma

Georg Aue1* and Thorsten Austein21 Hematology Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland

2 Internal Medicine, St. Bernhard Hospital, Brake, Germany

A 60-year-old female with a past medical history ofosteoporosis presented to the emergency room with a chiefcomplaint of chest pain and dyspnea.The patient was hypotensive, febrile (1038F), and

required emergent intubation. Vancomycin and ceftazidimewere initiated.The chest X-ray was unremarkable; however, the leuko-

cyte count was 1,000 per cubic milliliter, the hemoglobinwas 11.5 g/dl, and the platelet count was 76,000 per cubicmilliliter. The creatinine was 2.6 g/dl, and the lactate dehy-drogenase was 650 IU/l.

May-Grunwald and Giemsa staining of the peripheralblood smear (image. 1) showed lancet-shaped cocci inpairs (arrow). The bone marrow aspirate (was image. 2,May-Grunwald and Giemsa staining) confirmed cocci with aclear zone (arrow), indicating the presence of an encapsu-lated organism, which is typical for Streptococcus pneumo-niae, and revealed increased numbers of plasma cells con-sistent with multiple myeloma.The patient died 4 h after admission from multisystem

organ failure. Blood cultures grew Streptococcus pneumo-niae 1 day later.

Image 1. Peripheral blood smear (May-Grunwald andGiemsa staining) showed lancet-shaped cocci in pairs(arrow).

Image 2. Bone marrow aspirate (May-Grunwald andGiemsa staining) confirmed cocci with a clear zone(arrow), typical for Streptococcus pneumoniae.

*Correspondence to: Georg Aue, MD, Hematology Branch, National Heart,Lung, and Blood Institute, National Institutes of Health, Building 10, CRCRoom 3-3216, 10 Center Drive (MSC 1202), Bethesda, MD 20892-1202.E-mail: [email protected]

Received for publication 5 January 2007; Revised 15 January 2007; Accepted18 January 2007

Am. J. Hematol. 82:858, 2007.

Published online 15 May 2007 in Wiley InterScience (www.interscience.wiley.com).DOI: 10.1002/ajh.20911

Published 2007 Wiley-Liss, Inc. {This article is a US Government work and,as such, is in the public domain in the United States of America.

American Journal of Hematology 858 http://www3.interscience.wiley.com/cgi-bin/jhome/35105