To the Editor.—
Greene et al1 report a patient with sickle cell anemia who died of fulminant pneumococcal bacteremia and had watery diarrhea as a symptom. We recently saw a patient without sickle cell anemia but with apparent hyposplenia and pneumococcal sepsis who was initially seen with severe diarrhea.
Report of a Case.—
A 54-year-old black woman was admitted to the hospital with a two-day history of fever, shaking chills, nausea, and vomiting. She reported severe profuse diarrhea, with bowel movements occurring almost every hour. Her history was notable only for hypertension that was treated with thiazide diuretics. At time of admission, her temperature was 39.4°C; blood pressure, 116/60 mm Hg; pulse, 100 beats per minute; and respirations, 20/min. She was obese, lethargic, and disoriented. The neck was supple and neurological examination was nonfocal. Scattered coarse rhonchi were heard throughout her lungs and there were no heart murmurs. Results
Rio CD, McGowan JE. Severe Diarrhea in Pneumococcal Bacteremia: Croupous Colitis. JAMA. 1987;257(2):189. doi:10.1001/jama.1987.03390020055020