Recurrent meningitis caused by Streptococcus pneumoniae serotype 15C associated with Wiskott-Aldrich syndrome

Abstract

Streptococcus pneumoniae is an encapsulated bacterium capable of causing invasive disease in susceptible individuals, including immunocompromised and asplenic patients. Wiskott-Aldrich syndrome (WAS) is a primary immunodeficiency disease with myriad manifestations; it can cause thrombocytopenia, platelet dysfunction, selective antibody deficiency, and predisposition to bacterial infections. A 24-year-old Métis man presented to a Northern Ontario emergency department with several days’ history of malaise, headache, and nuchal rigidity. Within 5 months, he presented again with similar symptoms. In both instances, S. pneumoniae serotype 15C was isolated from his cerebrospinal fluid. He was successfully treated with cefotaxime both times. The patient’s past medical history included WAS, splenectomy, Epstein-Barr virus-associated lymphoma treated with bone marrow transplant, and prior cases of pneumococcal meningitis and pneumonia. He was restarted on indefinite penicillin V prophylaxis. This is the first described case of WAS in a man of mixed European and Indigenous North American descent. We report recurrent invasive pneumococcal disease in an asplenic individual caused by an emerging invasive serotype.