Cellulitis complicated by Streptococcus pneumoniae abscess in a preschooler

Abstract

Introduction: Pneumococcal cellulitis is a rare form of invasive disease caused by Streptococcus pneumoniae or pneumococcus, with facial location being the most common and gluteal location very uncommon. Objective: To describe an atypical case of gluteal cellulitis complicated by abscess with isolation of S. pneumoniae in a previously healthy child. Case description: A 2-year-and-5-month-old female patient, with no relevant personal history and up-to-date vaccinations, presented with edema, hyperemia, and pain in the right gluteal region one week before hospital admission. The inflammatory signs appeared ten days after receiving an intramuscular injection at the site and worsened despite a previous course of antibiotics to control otitis media. On examination, she presented with a hardened swelling and phlogosis. Ultrasound confirmed the presence of a subcutaneous abscess (5.2 x 4.4 x 3.9 cm). She underwent surgical drainage with drain placement. The secretion culture was positive for S. pneumoniae, while the blood culture was negative. After drainage and initiation of antibiotic therapy, she had good clinical progress and was discharged after eight days. Discussion: This case demonstrates a rare presentation of invasive pneumococcal disease, condition preventable by vaccination. S. pneumoniae should be considered an etiological agent of cellulitis, even without an adjacent infectious focus. Intramuscular injection trauma is a likely risk factor, serving as a portal of entry through inoculation or facilitating infection during bacteremia. Surgical drainage was crucial for etiological diagnosis and effective treatment.