Volume 68 Number 6 November 2001	back to contents

Pneumococcal Vaccine Failure in an HIV-Infected Patient with Fatal Pneumococcal Sepsis and HCV-Related Cirrhosis	396-399
Martin Begemann, M.D. and Maurice Policar, M.D.
From the Department of Medicine, Elmhurst Hospital, Elmhurst, NY. Address correspondence to Martin Begemann, M.D., Department of Neurology, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, NY 10021.

ABSTRACT
Pneumoccocal vaccination of HIV-positive individuals is recommended to prevent pneumococcal infection. We present a case of a 44-year-old HIV-infected male who came to the emergency room with bacterial pneumonia and sepsis. The patient also had a history of HBV and HCV infection. He expired in the emergency room and blood cultures were positive for Streptococcus pneumoniae. The autopsy confirmed the clinical diagnosis and, in addition, hepatitis C-related cirrhosis and splenic abnormalities. The patient had no history of opportunistic infections. His CD4 count 3 months prior to coming to the emergency room was 216 cells/µL with a viral load of 1,270 copies/mL. The patient had received Pneumovax^TM two years before his death. The organism isolated from blood cultures was Streptococcus pneumoniae isotype 3, a strain included in Pneumovax. This is a case of pneumococcal vaccine failure with a fatal outcome in a person with an HIV infection and hepatitis C-related liver cirrhosis.

KEY WORDS
S. pneumoniae, isotype 3, vaccine, Pneumovax, HIV, pneumonia, sepsis, HCV, cirrhosis.

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