Fulminant Pneumococcal Meningoencephalitis and Widespread Cerebritis with Multiple Infarctions Caused by Non–PCV13-Serotype 23A in a 12-Month-Old Girl with Down Syndrome

Streptococcus pneumoniae is one of the major pathogens in invasive diseases in children worldwide. The implementation of national vaccine programs has led to a significant reduction in most circulating pathogenic serotypes. Because of genetic shifts and replacements in the S. pneumoniae population, rare and nonvaccine serotypes have increased in prevalence. We report a case of a 12-month-old girl with Down syndrome and congenital heart disease, suffering from a fulminant pneumococcal meningoencephalitis caused by the nonvaccine serotype 23A. This nonvaccine serotype is an example of the increasing incidence in children with invasive pneumococcal disease (IPD) and illustrates the need for pneumococcal vaccines with broader coverage. Cranial computed tomography (CCT) findings of the patient revealed unusual and extended lesions with bi-hemispheric infarctions and cerebritis, with subsequent widespread intraparenchymal hemorrhage.