Sepsis with Streptoccocus Pneumoniae in a child with nephrotic syndrome

Introduction. Nephrotic syndrome is one of the most frequent glomerular pathologies encountered in pediatric ages, with an incidence of 4.7 cases in 100,000 children. The most frequent infectious complication of nephrotic syndrome is bacterial peritonitis caused most of the times by Streptococcus pneumoniae, a microorganism responsible by a high number of pneumonia, otitis media and sepsis episodes among children. Case report. We present the case of a 4.7-year-old male patient, diagnosed with nephrotic syndromes with 2 recurrences and transitory hypertension, admitted in our clinic for: diffuse abdominal pain, vomiting, diarrhea, fever and right otalgia. The laboratory tests on the day of admission pointed out elevated inflammatory biomarkers, leukocytosis, anemia and combined dyslipidemia. The urinary exam showed massive proteinuria. The blood culture was positive for Streptococcus Pneumoniae. The abdominal ultrasound revealed mild ascites, the thoracic radiography ruled out a pneumonia, and the ENT exam pointed out erythematous and bulged tympanic membrane. We initiated empirical therapy with Ceftriaxone, steroids and symptomatic drugs. After 3 weeks of hospitalization, the patient is discharged in good general status, with remission of nephrotic syndrome. Conclusions. Congestive acute otitis media can lead in case of immunosuppressed patients to a severe sepsis with Streptococcus pneumoniae. Thus, anti-pneumococcal vaccination is mandatory, especially in case of high risk patients.