Recurrent presumed septic wrist arthritis caused by a non-vaccine serotype of Streptococcus pneumoniae following traumatic partial splenectomy: A case report

Streptococcus pneumoniae is a leading cause of respiratory infections and invasive pneumococcal disease, especially in individuals with asplenia. We report the case of a 39-year-old man who underwent partial splenectomy and developed recurrent presumed septic arthritis caused by S. pneumoniae serotype 24 F/24 A/24B, a non-vaccine serotype, despite receiving both 23-valent pneumococcal polysaccharide and pneumococcal conjugate vaccines. The patient had previously experienced two episodes of pneumococcal and staphylococcal septic arthritis in different joints. The patient presented with acute wrist monoarthritis, which was successfully treated with intravenous antibiotics and did not require surgical drainage. This case illustrates the limitations of current pneumococcal vaccines in protecting against non-vaccine serotypes and underscores the importance of clinical vigilance and prompt management of serious infections in patients with hyposplenia. • Hyposplenia after traumatic partial splenectomy predisposed to invasive pneumococcal disease. • Acute wrist monoarthritis developed concurrently with Streptococcus pneumoniae bacteremia. • Marked swelling, erythema, warmth, and severe pain on passive range of motion raised concern for septic arthritis. • Repeated imaging showed no aspiratable effusion or drainable collection, precluding synovial sampling. • Recurrent episodes were associated with a non-vaccine serotype of Streptococcus pneumoniae, highlighting diagnostic and preventive challenges.